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General NPI Number Information
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NPI Number | 1710022207
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Entity Type | Organization
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Legal Business Name | SKIDAWAY VILLAGE PHARMACY INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 1 SKIDAWAY VILLAGE WALK
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City | SAVANNAH
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State | GA
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Zip | 31411-2908
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Country | US
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Telephone | 912-598-8669
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Fax | 912-598-7208
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Provider Business Mailing Address
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Address Line | 1 SKIDAWAY VILLAGE WALK
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City | SAVANNAH
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State | GA
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Zip | 31411-2908
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Country | US
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Telephone | 912-598-8669
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Fax | 912-598-7208
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. JASON PAUL CONLEY
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Credential | PHARMD
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Telephone | 912-598-8669
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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 | PHRE008485
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License Number State | GA
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