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General NPI Number Information
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NPI Number | 1801274956
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Entity Type | Organization
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Legal Business Name | SONORAVILLE PHARMACY, INC.
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Dates
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Enumeration Date | 05/09/2015
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Last Update Date | 05/09/2015
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Provider Practice Location Address
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Address Line | 6824 FAIRMOUNT HWY SE
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City | CALHOUN
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State | GA
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Zip | 30701-4019
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Country | US
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Telephone | 706-383-8604
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Fax | 706-383-8658
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Provider Business Mailing Address
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Address Line | 6824 FAIRMOUNT HWY SE
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City | CALHOUN
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State | GA
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Zip | 30701-4019
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Country | US
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Telephone | 706-383-8604
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Fax | 706-383-8658
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. LARRY RALPH JOHNSTON
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Credential | RPH.
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Telephone | 706-383-8604
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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 | PHRE010145
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License Number State | GA
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