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General NPI Number Information
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NPI Number | 1952316721
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Entity Type | Organization
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Legal Business Name | CITY DRUG STORE
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 1402 NEWCASTLE ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-7018
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Country | US
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Telephone | 912-265-7630
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Fax | 912-262-1123
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Provider Business Mailing Address
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Address Line | 1402 NEWCASTLE ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-7018
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Country | US
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Telephone | 912-265-7630
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Fax | 912-262-1123
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Authorized Official
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Title or Position | OWNER RPH
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Name | MR. CHARLES ROBERT LOTT
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Credential | PHARMACIST
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Telephone | 912-265-7630
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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 | 005563
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License Number State | GA
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