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General NPI Number Information
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NPI Number | 1730115619
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Entity Type | Organization
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Legal Business Name | BRASSTOWN PROFESSIONAL PHARMACY, INC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 23 MURPHY HWY STE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3157
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Country | US
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Telephone | 706-745-2303
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Fax | 706-745-2333
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Provider Business Mailing Address
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Address Line | 23 B MURPHY HIGHWAY
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City | BLAIRSVILLE
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State | GA
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Zip | 30512
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Country | US
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Telephone | 706-745-2303
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Fax | 706-745-2333
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY S GALLOWAY
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Credential | R.PH., COF
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Telephone | 706-745-2303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 8635
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | D19680
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 8635
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C22010
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8635
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License Number State | GA
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