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General NPI Number Information
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NPI Number | 1417598327
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Entity Type | Organization
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Legal Business Name | CONNECT CARE PHARMACY, LLC
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 2191 HWY 247 CONNECTOR
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City | BYRON
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State | GA
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Zip | 31008-5531
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Country | US
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Telephone | 478-654-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 2191 GA HWY 247 CONNECTOR
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City | BYRON
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State | GA
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Zip | 31008-5531
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Country | US
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Telephone | 478-654-5222
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Fax | 478-654-5209
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Authorized Official
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Title or Position | OWNER/PIC
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Name | DR. GUILLIANO FORTUNE
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Credential | PHARMD
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Telephone | 478-654-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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