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Organization
OLDE TIME PHARMACY AT SIXES LLC
Active
Organization
OLDE TIME PHARMACY AT SIXES LLC
Active
Other names
Olde Time Pharmacy at Sixes, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SHAD SUTHERLAND (OWNER)
(770) 783-0483
Entity
Organization
Contact information
Practice address
684 SIXES RD STE 105, HOLLY SPRINGS, GA 30115-8720
(770) 783-0483
Mailing address
684 SIXES RD, SUITE 105, HOLLY SPRINGS, GA 30115-8721
(770) 783-0483
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009711
GA
Other
Enumeration date
11/12/2010
Last updated
12/01/2010
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