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General NPI Number Information
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NPI Number | 1285728329
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Entity Type | Organization
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Legal Business Name | RIVER ROAD PHARMACY
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 5100 RIVER RD
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City | COLUMBUS
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State | GA
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Zip | 31904-5841
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Country | US
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Telephone | 706-317-2583
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Fax | 706-317-2587
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Provider Business Mailing Address
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Address Line | 5100 RIVER RD
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City | COLUMBUS
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State | GA
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Zip | 31904-5841
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Country | US
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Telephone | 706-317-2583
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Fax | 706-317-2587
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN COLQUITT LOGAN JR.
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Credential | PHARMD
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Telephone | 706-317-2583
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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 | PHRE008749
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License Number State | GA
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