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General NPI Number Information
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NPI Number | 1164859245
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Entity Type | Organization
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Legal Business Name | PRIME RX PHARMACY, INC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 1500 MOUNT ZION RD SUITE 104
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City | MORROW
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State | GA
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Zip | 30260-4155
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Country | US
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Telephone | 770-968-3444
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Fax | 770-968-3666
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Provider Business Mailing Address
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Address Line | 1500 MOUNT ZION RD SUITE 104
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City | MORROW
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State | GA
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Zip | 30260-4155
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Country | US
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Telephone | 770-968-3444
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Fax | 770-968-3666
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHNSON SORTI BESONG
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Credential |
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Telephone | 404-358-0620
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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 | PHRE009963
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License Number State | GA
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