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General NPI Number Information
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NPI Number | 1851446454
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Entity Type | Organization
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Legal Business Name | SLS PHARMACY INC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 561 EAST MAIN STREET
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City | WILLACOOCHEE
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State | GA
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Zip | 31650
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Country | US
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Telephone | 912-534-5195
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Fax | 912-534-6383
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | WILLACOOCHEE
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State | GA
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Zip | 31650-0190
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Country | US
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Telephone | 912-534-5195
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Fax | 912-534-6383
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMMY STORY
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Credential | RPH
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Telephone | 912-534-5195
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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 | PHRE006506
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License Number State | GA
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