# PRUITTHEALTH PHARMACY SERVICES - VALDOSTA, INC.

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

## Provider details

- **NPI number:** 1609823061
- **Authorized official:** MR. NEIL L PRUITT JR. (CHAIRMAN AND CEO)
- **Authorized official phone:** (770) 279-6200

## Contact information

- **Practice address:** 1711 RIVER ST, VALDOSTA, GA 31601-5163
- **Practice address phone:** (229) 244-8868
- **Mailing address:** 1626 JEURGENS CT, NORCROSS, GA 30093-2219
- **Mailing address phone:** (678) 533-6382
- **Mailing address fax:** (770) 931-5278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/30/2006
- **Last updated:** 06/03/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00344044A | — | GA |