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General NPI Number Information
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NPI Number | 1760790414
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Entity Type | Organization
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Legal Business Name | PERSONAL MEDICATION CONSULTING, P.C.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 6677 GLENMORE WAY
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City | COLUMBUS
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State | GA
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Zip | 31904-2466
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Country | US
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Telephone | 706-249-1680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | FORTSON
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State | GA
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Zip | 31808-0535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRYAN KEITH BONNER
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Credential | R.PH.
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Telephone | 706-249-1680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number | 017193
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License Number State | GA
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