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General NPI Number Information
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NPI Number | 1124584214
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Entity Type | Organization
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Legal Business Name | PHARMA ST RX LLC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 519 S SCOTT ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4101
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Country | US
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Telephone | 239-495-3133
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Fax | 229-329-4432
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Provider Business Mailing Address
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Address Line | 519 S SCOTT ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4101
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Country | US
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Telephone | 229-495-3133
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Fax | 239-329-4432
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Authorized Official
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Title or Position | OWNER
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Name | DILLON GREENE
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Credential |
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Telephone | 561-715-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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