=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700292968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIGHBORHOOD IMPROVEMENT PROJECT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2014
-----------------------------------------------------
Last Update Date | 12/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2467 GOLDEN CAMP RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-5515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-922-0682
-----------------------------------------------------
Fax | 706-922-0683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2467 GOLDEN CAMP RD
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-5515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-922-0682
-----------------------------------------------------
Fax | 706-922-0683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | PURNANK GANDHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-922-0682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010049
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------