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Organization
PRUITTHEALTH PHARMACY SERVICES - VALDOSTA, INC.
Active
Organization
PRUITTHEALTH PHARMACY SERVICES - VALDOSTA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL L PRUITT JR. (CHAIRMAN AND CEO)
(770) 279-6200
Entity
Organization
Contact information
Practice address
1711 RIVER ST, VALDOSTA, GA 31601-5163
(229) 244-8868
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(678) 533-6382
(770) 931-5278
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00344044A
—
GA
Enumeration date
05/30/2006
Last updated
06/03/2021
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