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General NPI Number Information
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NPI Number | 1194345777
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA DRUG COMPANY LLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1202 US HIGHWAY 41 N
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City | TIFTON
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State | GA
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Zip | 31794-3202
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Country | US
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Telephone | 229-563-6689
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Fax |
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Provider Business Mailing Address
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Address Line | 39 HUNTERS WOOD AVE
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City | TIFTON
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State | GA
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Zip | 31794-2072
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Country | US
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Telephone | 229-586-8193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCAS BROWN
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Credential |
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Telephone | 229-586-8193
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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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