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Organization
NYOTA
Active
Organization
NYOTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THADDEUS ALTONIO BLUE PHARM.D (DIRECTOR)
(678) 933-1711
Entity
Organization
Contact information
Practice address
58 FLAT SHOALS AVE SE, ATLANTA, GA 30316-1337
(404) 399-5124
Mailing address
58 FLAT SHOALS AVE SE, ATLANTA, GA 30316-1337
(404) 399-5124
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
019367
GA
Other
Enumeration date
08/04/2006
Last updated
08/22/2020
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