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General NPI Number Information
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NPI Number | 1497791305
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Entity Type | Organization
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Legal Business Name | SUMMERVILLE PHARMACY INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 2839 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30909-3904
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Country | US
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Telephone | 706-481-7140
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Fax | 706-733-7301
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Provider Business Mailing Address
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Address Line | PO BOX 2986
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City | AUGUSTA
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State | GA
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Zip | 30914-2986
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Country | US
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Telephone | 706-481-7140
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Fax | 706-733-7301
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROB WOODS
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Credential |
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Telephone | 706-481-7140
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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 | PHRE004193
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License Number State | GA
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