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Organization
LA FAYETTE PRESCRIPTION SHOP
Active
Organization
LA FAYETTE PRESCRIPTION SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD EZELL (PRESIDENT)
(423) 653-1750
Entity
Organization
Contact information
Practice address
700 E VILLANOW ST, LA FAYETTE, GA 30728-2619
(706) 638-4347
(706) 638-7236
Mailing address
701 SUNSET MT DRIVE, CHATTANOOPA, TN 37421
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006067
GA
Other
Enumeration date
11/13/2006
Last updated
07/19/2007
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