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Organization
DKL31092 INC
Active
Organization
DKL31092 INC
Active
Other names
MONTEZUMA DRUG COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD LANE RPH (OWNER)
(478) 472-7561
Entity
Organization
Contact information
Practice address
112 S DOOLY ST, MONTEZUMA, GA 31063-1604
(478) 472-7561
(478) 472-5887
Mailing address
PO BOX 250, MONTEZUMA, GA 31063-0250
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE003393
GA
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Enumeration date
04/19/2006
Last updated
04/21/2010
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