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Organization
KENNESTONE HOSPITAL, INC
Active
Organization
KENNESTONE HOSPITAL, INC
Active
Other names
WellStar Pharmacy Network
Organization subpart
No
Provider details
NPI number
Authorized official
EBENEZER ERZUAH (EXEC DIRECTOR REIMBURSEMENT)
(470) 956-4981
Entity
Organization
Contact information
Practice address
3950 AUSTELL RD, SUITE 8, AUSTELL, GA 30106-1121
(470) 732-2111
(678) 495-8798
Mailing address
PO BOX 741705, ATLANTA, GA 30374-1705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
Other
Enumeration date
03/21/2011
Last updated
05/06/2020
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