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General NPI Number Information
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NPI Number | 1144555996
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Entity Type | Organization
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Legal Business Name | PIERCE FAMILY PHARMACY INC
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 3150 US HIGHWAY 84
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City | BLACKSHEAR
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State | GA
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Zip | 31516-4944
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Country | US
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Telephone | 912-449-1400
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Fax | 912-449-1404
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Provider Business Mailing Address
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Address Line | 3150 US HIGHWAY 84
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City | BLACKSHEAR
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State | GA
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Zip | 31516-4944
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Country | US
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Telephone | 912-449-1400
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Fax | 912-449-1404
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Authorized Official
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Title or Position | PRESIDENT,PIC, AO
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Name | ZAVAIN MARDIROSSIAN
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Credential |
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Telephone | 912-449-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009610
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License Number State | GA
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