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General NPI Number Information
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NPI Number | 1245799857
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Entity Type | Organization
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Legal Business Name | DOGWOOD PHARMACY LTC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1909 US HIGHWAY 82 W STE 11
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City | TIFTON
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State | GA
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Zip | 31793-8213
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Country | US
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Telephone | 229-256-2411
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Fax | 229-256-2488
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Provider Business Mailing Address
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Address Line | 1909 US HIGHWAY 82 W STE 11
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City | TIFTON
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State | GA
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Zip | 31793-8213
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Country | US
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Telephone | 229-256-2411
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Fax | 229-256-2488
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | LAURA EUGENA TYSON
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Credential |
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Telephone | 229-316-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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