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General NPI Number Information
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NPI Number | 1942279278
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Entity Type | Organization
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Legal Business Name | PHARMACEUTICAL CONCEPTS PC
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 6102 BANKS ST
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City | LULA
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State | GA
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Zip | 30554-5114
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Country | US
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Telephone | 770-869-3616
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Fax | 770-869-9080
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Provider Business Mailing Address
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Address Line | PO BOX 436
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City | LULA
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State | GA
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Zip | 30554-0436
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Country | US
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Telephone | 770-869-3616
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Fax | 770-869-9080
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Authorized Official
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Title or Position | PIC
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Name | AMY MILLER
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Credential | BS PHARMACY
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Telephone | 770-869-3616
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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 | PHRE006369
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License Number State | GA
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