# VILLA RICA RX LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** VILLA RICA DRUGS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619262433
- **Authorized official:** MR. COLTON HAROLD BLACKMON PHARM D (OWNER)
- **Authorized official phone:** (770) 456-4663

## Contact information

- **Practice address:** 222 WEST WILSON STREET, VILLA RICA, GA 30180
- **Practice address phone:** (770) 456-4663
- **Practice address fax:** (770) 456-4661
- **Mailing address:** 222 WEST WILSON STREET, VILLA RICA, GA 30180
- **Mailing address phone:** (770) 456-4663
- **Mailing address fax:** (770) 456-4661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE009763 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE010412 | GA | Yes |

## Other

- **Enumeration date:** 06/09/2011
- **Last updated:** 06/26/2018