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Organization
SOUTHERN PAIN INSTITUTE P C
Active
Organization
SOUTHERN PAIN INSTITUTE P C
Active
Other names
Parish Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN CLAVO (CHIEF PHARMACIST)
(770) 313-3380
Entity
Organization
Contact information
Practice address
1975 HIGHWAY 54 W STE 100, FAYETTEVILLE, GA 30214-4794
(770) 631-5158
(770) 632-3731
Mailing address
1975 HIGHWAY 54 W, SUITE 100, FAYETTEVILLE, GA 30214-4794
(770) 631-5158
(404) 591-7959
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009784
GA
3336C0004X
Compounding Pharmacy
—
NULL
Other
Enumeration date
09/28/2011
Last updated
03/20/2013
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