=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912492091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYER APOTHECARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2018
-----------------------------------------------------
Last Update Date | 03/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178 BRACKETTS WAY SUITE 7
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-400-5043
-----------------------------------------------------
Fax | 706-400-5046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 PEACHTREE ST
-----------------------------------------------------
City | MURPHY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-400-5043
-----------------------------------------------------
Fax | 706-400-5046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JOHN HYER
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 706-400-5043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010631
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------