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General NPI Number Information
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NPI Number | 1508870155
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Entity Type | Organization
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Legal Business Name | UNIVERSAL PHARM INC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 298 MEDICAL COURT
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City | OGLETHORPE
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State | GA
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Zip | 31068
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Country | US
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Telephone | 478-472-2040
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Fax | 912-472-9822
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Provider Business Mailing Address
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Address Line | PO BOX 322
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City | OGLETHORPE
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State | GA
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Zip | 31068-0322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDY KEENE
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Credential | PHRM
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Telephone | 478-472-2040
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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 | PHRE006910
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License Number State | GA
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