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General NPI Number Information
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NPI Number | 1780680652
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Entity Type | Organization
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Legal Business Name | NURSING HOME PHARMACY LLC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 1865 BOLD SPRINGS RD NW
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City | MONROE
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State | GA
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Zip | 30656-4605
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Country | US
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Telephone | 770-267-8677
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Fax | 770-267-6462
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Provider Business Mailing Address
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Address Line | 1865 BOLD SPRINGS RD NW
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City | MONROE
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State | GA
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Zip | 30656-4605
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Country | US
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Telephone | 770-267-8677
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Fax | 770-267-6462
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN GLEATON
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Credential | BS PHARMACY
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Telephone | 770-267-8677
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE004071
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License Number State | GA
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