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General NPI Number Information
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NPI Number | 1609959766
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Entity Type | Organization
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Legal Business Name | HEART PHARMACY, INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 706 SPRINGDALE DR
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City | RIVERDALE
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State | GA
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Zip | 30274-2327
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Country | US
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Telephone | 770-997-6500
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Fax | 770-909-0737
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Provider Business Mailing Address
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Address Line | 706 SPRINGDALE DR
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City | RIVERDALE
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State | GA
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Zip | 30274-2327
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Country | US
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Telephone | 770-997-6500
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Fax | 770-909-0737
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Authorized Official
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Title or Position | CEO / CHIEF PHARMACIST
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Name | MR. MARVIN WEYMAN GRIFFIN SR.
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Credential | RPH
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Telephone | 770-997-6500
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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 | 9038
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License Number State | GA
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