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General NPI Number Information
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NPI Number | 1174000673
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Entity Type | Individual
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Provider Name | JACOB CHARLES PUGH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 6615 ROSWELL RD
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-3190
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Country | US
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Telephone | 404-843-4346
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 BLUE STONE RD UNIT 4026
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-3962
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Country | US
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Telephone | 317-409-9482
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH030733
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License Number State | GA
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