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General NPI Number Information
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NPI Number | 1912293770
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Entity Type | Organization
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Legal Business Name | CRT PHARMACY
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1260 S MILLEDGE AVE STE F-1
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City | ATHENS
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State | GA
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Zip | 30605-1496
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Country | US
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Telephone | 706-543-7386
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Fax | 706-543-8544
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Provider Business Mailing Address
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Address Line | 1260 S MILLEDGE AVE STE F-1
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City | ATHENS
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State | GA
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Zip | 30605
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Country | US
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Telephone | 706-543-7386
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Fax | 706-543-8544
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Authorized Official
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Title or Position | VICE PRESIDENT/PIC/OWNER
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Name | RABUN WILEY NEVES
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Credential | PHARMD
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Telephone | 706-543-7386
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE000062
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License Number State | GA
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