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General NPI Number Information
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NPI Number | 1831602077
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Entity Type | Organization
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Legal Business Name | SOUTHERN DRUG COMPANY, INC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 4075 E FIRST ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4526
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Country | US
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Telephone | 706-455-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 4075 E FIRST ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4526
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Country | US
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Telephone | 706-455-2288
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT
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Name | DR. CHRISTINA SUZANNE DAVENPORT
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Credential | PHARM.D.
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Telephone | 706-455-2288
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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 | PHRE010405
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License Number State | GA
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