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General NPI Number Information
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NPI Number | 1548260144
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Entity Type | Organization
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Legal Business Name | DEKALB COMMUNITY SERVICE BOARD
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3807 CLAIRMONT RD
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City | CHAMBLEE
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State | GA
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Zip | 30341-4911
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Country | US
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Telephone | 770-457-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 3807 CLAIRMONT RD
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City | CHAMBLEE
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State | GA
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Zip | 30341-4911
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Country | US
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Telephone | 770-457-6236
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARY S RICHEY
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Credential | MBA
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Telephone | 404-294-3836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007051
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License Number State | GA
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