# PULASKI STATE PRISON REGIONAL PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GEORGIA DEPARTMENT OF CORRECTIONS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902397995
- **Legal business name:** GEORGIA DEPARTMENT OF CORRECTIONS
- **Authorized official:** RANDY GOODROE RPH (PHARMACY DIRECTOR)
- **Authorized official phone:** (478) 783-6097

## Contact information

- **Practice address:** 373 UPPER RIVER RD, HAWKINSVILLE, GA 31036-8898
- **Practice address phone:** (478) 783-6097
- **Practice address fax:** (478) 783-6252
- **Mailing address:** 373 UPPER RIVER RD, HAWKINSVILLE, GA 31036-8898
- **Mailing address phone:** (478) 783-6097
- **Mailing address fax:** (478) 783-6252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | PHPR007792 | GA | Yes |

## Other

- **Enumeration date:** 05/24/2018
- **Last updated:** 05/24/2018