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Organization
PUBLIX PHARMACY
Active
Organization
PUBLIX PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA KELLER (PHARMACIST)
(561) 312-3708
Entity
Organization
Contact information
Practice address
1109 S PARK ST, CARROLLTON, GA 30117-4462
(770) 214-3146
Mailing address
301 JOHN GORDON PL, CARROLLTON, GA 30116-7574
(561) 312-3718
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013197
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH0013197
GA PHARMACIST LICENSE NUMBER
GA
Enumeration date
07/29/2015
Last updated
07/29/2015
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