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Organization
BUDD TERRACE PHARMACY
Active
Organization
BUDD TERRACE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HANICHEN (DIRECTOR OF PHARMACY)
(404) 728-6807
Entity
Organization
Contact information
Practice address
1833 CLIFTON RD NE, ROOM 115, ATLANTA, GA 30329-4021
(404) 728-6807
Mailing address
1833 CLIFTON RD NE, ROOM 115, ATLANTA, GA 30329-4021
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHRE009863
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FB3481998
CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE
—
01
—
PHRE009863
GEORGIA BOARD OF PHARMACY
GA
Enumeration date
10/08/2012
Last updated
10/08/2012
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