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General NPI Number Information
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NPI Number | 1952318834
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Entity Type | Organization
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Legal Business Name | HARBIN CLINIC LLC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1825 MARTHA BERRY BLVD NW
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City | ROME
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State | GA
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Zip | 30165-1625
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Country | US
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Telephone | 706-378-8191
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Fax | 706-378-8192
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Provider Business Mailing Address
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Address Line | 221 TECHNOLOGY PKWY NW
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City | ROME
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State | GA
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Zip | 30165-1369
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Country | US
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Telephone | 762-235-2440
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Fax | 706-378-8192
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEPHEN PLEDGER
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Credential | PHARMD
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Telephone | 762-235-2440
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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 | PHRE009008
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License Number State | GA
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