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General NPI Number Information
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NPI Number | 1558427468
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Entity Type | Organization
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Legal Business Name | HOSPITAL PHARMACY OF MOULTRIE INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 203 31ST AVE SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6703
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Country | US
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Telephone | 229-985-9296
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Fax | 229-985-3771
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Provider Business Mailing Address
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Address Line | PO BOX 861
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City | MOULTRIE
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State | GA
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Zip | 31776-0861
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Country | US
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Telephone | 229-985-9296
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Fax | 229-891-3771
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY L YARBROUGH
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Credential | R.PH.
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Telephone | 229-985-9296
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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 | 4738
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License Number State | GA
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