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General NPI Number Information
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NPI Number | 1376057570
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Entity Type | Organization
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Legal Business Name | GOLDEN TOWN PHARMACY, LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 2837 HIGHWAY 501 EAST
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City | AYNOR
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State | SC
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Zip | 29511
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Country | US
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Telephone | 843-992-6243
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Fax |
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Provider Business Mailing Address
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Address Line | 2837 HIGHWAY 501 EAST
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City | AYNOR
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State | SC
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Zip | 29511
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Country | US
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Telephone | 843-358-7777
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Fax | 843-358-7775
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHNNY RAY CAPPS
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Credential | RPH
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Telephone | 843-358-7777
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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 | 17613
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License Number State | SC
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