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General NPI Number Information
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NPI Number | 1669407169
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Entity Type | Organization
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Legal Business Name | REAGANS PHARMACY INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 1600 MILSTEAD RD NE
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City | CONYERS
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State | GA
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Zip | 30012-3738
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Country | US
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Telephone | 770-483-4727
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Fax | 770-483-4729
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Provider Business Mailing Address
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Address Line | 1600 MILSTEAD RD NE
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City | CONYERS
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State | GA
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Zip | 30012-3738
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Country | US
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Telephone | 770-483-4727
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Fax | 770-483-4729
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MR. JEFFREY B REAGAN
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Credential |
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Telephone | 770-483-4727
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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 | 3069
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License Number State | GA
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