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Organization
PROFESSIONAL MEDICAL PHARMACY
Active
Organization
PROFESSIONAL MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM PERNELL (ADMINISTRATOR)
(404) 299-7372
Entity
Organization
Contact information
Practice address
4859C MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
(404) 299-7372
(404) 508-9225
Mailing address
4859C MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
(404) 299-7372
(404) 508-9225
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH017641
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00814888A
—
GA
05
—
00814888B
—
GA
Enumeration date
02/20/2007
Last updated
08/22/2020
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