# BUDD TERRACE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255683843
- **Authorized official:** MICHAEL HANICHEN (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (404) 728-6807

## Contact information

- **Practice address:** 1833 CLIFTON RD NE, ROOM 115, ATLANTA, GA 30329-4021
- **Practice address phone:** (404) 728-6807
- **Mailing address:** 1833 CLIFTON RD NE, ROOM 115, ATLANTA, GA 30329-4021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PHRE009863 | GA | Yes |

## Other

- **Enumeration date:** 10/08/2012
- **Last updated:** 10/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | FB3481998 | CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE | — |
| 01 | — | PHRE009863 | GEORGIA BOARD OF PHARMACY | GA |