# LA FAYETTE PRESCRIPTION SHOP

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

## Provider details

- **NPI number:** 1780755793
- **Authorized official:** RICHARD EZELL (PRESIDENT)
- **Authorized official phone:** (423) 653-1750

## Contact information

- **Practice address:** 700 E VILLANOW ST, LA FAYETTE, GA 30728-2619
- **Practice address phone:** (706) 638-4347
- **Practice address fax:** (706) 638-7236
- **Mailing address:** 701 SUNSET MT DRIVE, CHATTANOOPA, TN 37421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE006067 | GA | Yes |

## Other

- **Enumeration date:** 11/13/2006
- **Last updated:** 07/19/2007