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General NPI Number Information
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NPI Number | 1992986756
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Entity Type | Organization
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Legal Business Name | UNIVERSITY HEALTHCARE SYSTEMS EMPLOYEE PHARMACY
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 1350 WALTON WAY
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City | AUGUSTA
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State | GA
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Zip | 30901-2629
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Country | US
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Telephone | 706-774-5348
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Fax | 706-774-5071
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Provider Business Mailing Address
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Address Line | 1350 WALTON WAY
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City | AUGUSTA
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State | GA
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Zip | 30901-2629
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Country | US
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Telephone | 706-774-5348
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Fax | 706-774-5071
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Authorized Official
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Title or Position | DIRECTOR, PHARMACY
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Name | RICHARD W SEVERSON
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Credential |
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Telephone | 706-774-5200
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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 | PHRE002074
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License Number State | GA
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