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Organization
MPT PHARMACY LLC
Active
Organization
MPT PHARMACY LLC
Active
Other names
Jackson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS DANIEL RAINEY PHARM.D. (PHARMACY MANAGER)
(706) 658-0064
Entity
Organization
Contact information
Practice address
170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
(706) 658-0064
(706) 654-0330
Mailing address
170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
(706) 658-0064
(706) 658-0330
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010068
GA
3336C0004X
Compounding Pharmacy
—
NULL
Other
Enumeration date
08/07/2014
Last updated
06/16/2025
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