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General NPI Number Information
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NPI Number | 1356595417
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Entity Type | Organization
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Legal Business Name | EXPRESS RX PHARMACY, LLC.
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Dates
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Enumeration Date | 11/15/2008
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 743 SHURLING DR
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City | MACON
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State | GA
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Zip | 31211-1947
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Country | US
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Telephone | 478-742-3020
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Fax | 478-742-3020
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Provider Business Mailing Address
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Address Line | 743 SHURLING DR
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City | MACON
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State | GA
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Zip | 31211-1947
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Country | US
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Telephone | 478-742-3020
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Fax | 478-742-3020
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MRS. BRIDGET JOYCE HOGAN
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Credential | PHARM D
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Telephone | 478-742-3020
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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 | PHRE009560
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License Number State | GA
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