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General NPI Number Information
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NPI Number | 1881084549
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Entity Type | Organization
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Legal Business Name | BI-LO PHARMACY
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 820 MISSON RIDGE ROAD
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City | ROSSVILLE
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State | GA
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Zip | 30741
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Country | US
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Telephone | 706-861-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 820 MISSON RIDGE RD.
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City | ROSSVILLE
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State | GA
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Zip | 30741
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Country | US
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Telephone | 706-861-6197
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | DR. STEVEN DAVID DEVERELL
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Credential | PHARMD
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Telephone | 706-861-6197
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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 | 023926
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License Number State | GA
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