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General NPI Number Information
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NPI Number | 1942798012
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Entity Type | Organization
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Legal Business Name | WEAVERS ROCKY FACE PHARMACY GROUP INC
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 2600 OLD CHATTANOOGA RD
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City | ROCKY FACE
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State | GA
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Zip | 30740-8511
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Country | US
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Telephone | 706-259-0668
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Fax | 706-259-1890
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Provider Business Mailing Address
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Address Line | 630 TI PI LN
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City | CHATSWORTH
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State | GA
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Zip | 30705-7786
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Country | US
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Telephone | 706-259-0668
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Fax | 706-971-3893
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Authorized Official
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Title or Position | CFO
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Name | PAUL P BRYANT
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Credential | RPH
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Telephone | 706-260-7998
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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 | PHRE010622
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License Number State | GA
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