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Organization
GEORGIA PHARMACY VENTURES LLC
Active
Organization
GEORGIA PHARMACY VENTURES LLC
Active
Other names
MAGNOLIA MANOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEE RPH (PRESIDENT)
(478) 783-4262
Entity
Organization
Contact information
Practice address
342 INDUSTRIAL BLVD, STE C, HAWKINSVILLE, GA 31036-2103
(478) 783-4262
(478) 783-8970
Mailing address
PO BOX 998, HAWKINSVILLE, GA 31036-0998
(478) 783-4262
(478) 783-8970
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PHRE009471
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017405
PK
—
Enumeration date
04/01/2008
Last updated
09/28/2016
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