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Organization
REXTOX CONSULTANT LLC
Active
Organization
REXTOX CONSULTANT LLC
Active
Other names
EVANSMILL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAPHAEL OGUNSUSI PHARMACIST (CEO)
(678) 478-9511
Entity
Organization
Contact information
Practice address
7525 COVINGTON HWY STE G, LITHONIA, GA 30058-7439
(678) 292-6025
(678) 292-6922
Mailing address
7525 COVINGTON HWY STE G, STONECREST, GA 30058-7439
(678) 292-6025
(678) 292-6922
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010633
GA
Other
Enumeration date
05/31/2018
Last updated
08/21/2018
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