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General NPI Number Information
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NPI Number | 1649520255
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Entity Type | Organization
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Legal Business Name | BECKY S DRUGSTORE LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 128 N BROAD ST
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City | BUENA VISTA
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State | GA
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Zip | 31803-2006
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Country | US
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Telephone | 229-649-3784
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Fax | 229-649-7455
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Provider Business Mailing Address
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Address Line | PO BOX 560
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City | BUENA VISTA
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State | GA
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Zip | 31803-0560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/RPH
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Name | BECKY POWELL
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Credential |
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Telephone | 229-314-1966
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009868
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License Number State | GA
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