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General NPI Number Information
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NPI Number | 1275185506
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Entity Type | Organization
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Legal Business Name | AUSTELL PHARMACY LLC
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 3802 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-5863
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Country | US
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Telephone | 770-726-2970
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Fax | 770-693-2375
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Provider Business Mailing Address
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Address Line | 3802 AUSTELL RD SW
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City | MARIETTA
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State | GA
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Zip | 30008-5863
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Country | US
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Telephone | 770-726-2970
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Fax | 770-693-2375
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | BRENDA KIGER
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Credential | RPH
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Telephone | 770-726-2970
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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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