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General NPI Number Information
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NPI Number | 1548304009
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Entity Type | Organization
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Legal Business Name | ELBERTON PHARMACY INC
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 556 ELBERT ST
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City | ELBERTON
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State | GA
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Zip | 30635-2347
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Country | US
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Telephone | 706-283-3161
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Fax | 706-283-3728
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Provider Business Mailing Address
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Address Line | 556 ELBERT ST
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City | ELBERTON
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State | GA
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Zip | 30635-2347
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Country | US
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Telephone | 706-283-3161
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Fax | 706-283-3728
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES MAXWELL THOMAS
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Credential | RPH
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Telephone | 706-283-3161
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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 | PHRE006440
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License Number State | GA
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