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General NPI Number Information
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NPI Number | 1639203110
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Entity Type | Organization
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Legal Business Name | PONCE INFECTIOUS DISEASE CENTER PHARMACY
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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 | 341 PONCE DE LEON AVE NE
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City | ATLANTA
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State | GA
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Zip | 30308-2012
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Country | US
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Telephone | 404-616-9783
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Fax |
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Provider Business Mailing Address
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Address Line | 80 JESSE HILL JR DR SE PO BOX 26041
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City | ATLANTA
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State | GA
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Zip | 30303-3031
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Country | US
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Telephone | 404-616-3576
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Fax | 404-616-6070
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MS. VALAURA D. HALLMAN
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Credential | RPH
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Telephone | 404-616-3576
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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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