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General NPI Number Information
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NPI Number | 1548394216
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Entity Type | Organization
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Legal Business Name | EAGLE'S LANDING PHARMACY III
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 46 KELLY RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-6012
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Country | US
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Telephone | 770-957-3661
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Fax | 770-898-1924
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Provider Business Mailing Address
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Address Line | 46 KELLY RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-6012
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Country | US
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Telephone | 770-957-3661
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Fax | 770-898-1924
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID THOMAS RINK
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Credential | RPH
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Telephone | 770-957-3661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE008381
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License Number State | GA
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