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General NPI Number Information
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NPI Number | 1710490891
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Entity Type | Organization
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Legal Business Name | MORTAR AND PESTLE, LLC
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1704 ROANOKE RD
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City | LAGRANGE
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State | GA
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Zip | 30240-3803
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Country | US
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Telephone | 706-298-4935
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Fax | 706-298-4934
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Provider Business Mailing Address
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Address Line | 300 MOOTY BRIDGE RD STE 208
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City | LAGRANGE
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State | GA
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Zip | 30240-1881
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Country | US
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Telephone | 706-298-4935
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN MEEKS
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Credential | PHARMD
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Telephone | 706-298-2714
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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 | PHRE010403
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License Number State | GA
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