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General NPI Number Information
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NPI Number | 1447349998
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Entity Type | Organization
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Legal Business Name | BAKCO ENTERPRISES,INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 3121 PEACH ORCHARD RD
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City | AUGUSTA
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State | GA
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Zip | 30906-3521
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Country | US
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Telephone | 706-792-5130
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Fax | 706-792-5132
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Provider Business Mailing Address
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Address Line | 3121 PEACH ORCHARD RD
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City | AUGUSTA
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State | GA
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Zip | 30906-3521
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Country | US
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Telephone | 706-792-5130
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Fax | 706-792-5132
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | KYLE PULLIAM
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Credential |
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Telephone | 706-854-2424
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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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