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General NPI Number Information
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NPI Number | 1548725807
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Entity Type | Organization
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Legal Business Name | CAMILLA DRUG COMPANY, LLC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 92 E BROAD ST
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City | CAMILLA
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State | GA
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Zip | 31730-1832
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Country | US
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Telephone | 229-522-3040
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Fax | 229-522-3074
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Provider Business Mailing Address
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Address Line | 92 E BROAD ST
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City | CAMILLA
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State | GA
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Zip | 31730-1832
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Country | US
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Telephone | 229-522-3040
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Fax | 229-522-3074
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Authorized Official
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Title or Position | PHARMACY MANAGER/PHARMACIST
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Name | JOESPH MCGALLIARD
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Credential | RPH
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Telephone | 229-336-6103
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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 |
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License Number State |
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