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General NPI Number Information
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NPI Number | 1255683843
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Entity Type | Organization
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Legal Business Name | BUDD TERRACE PHARMACY
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 1833 CLIFTON RD NE ROOM 115
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City | ATLANTA
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State | GA
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Zip | 30329-4021
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Country | US
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Telephone | 404-728-6807
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Fax |
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Provider Business Mailing Address
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Address Line | 1833 CLIFTON RD NE ROOM 115
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City | ATLANTA
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State | GA
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Zip | 30329-4021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MICHAEL HANICHEN
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Credential |
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Telephone | 404-728-6807
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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 | PHRE009863
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License Number State | GA
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