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General NPI Number Information
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NPI Number | 1609061647
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Entity Type | Organization
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Legal Business Name | TALLAPOOSA DRUG COMPANY INC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 24 W ALABAMA ST
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City | TALLAPOOSA
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State | GA
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Zip | 30176-1464
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Country | US
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Telephone | 770-574-2339
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Fax | 770-574-7307
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Provider Business Mailing Address
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Address Line | 24 W ALABAMA ST
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City | TALLAPOOSA
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State | GA
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Zip | 30176-1464
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Country | US
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Telephone | 770-574-2339
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Fax | 770-574-7307
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Authorized Official
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Title or Position | OWNER & PIC
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Name | RICKY GRIFFIN
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Credential | RPH
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Telephone | 770-574-2339
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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 | PHRE004796
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License Number State | GA
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