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Organization

TALLAPOOSA RX LLC

Active
Other names
Tallapoosa Drugs
Organization subpart
No

Provider details

NPI number
Authorized official
JACOB MOUCHET PHARM D (OWNER)
(770) 574-2339
Entity
Organization

Contact information

Practice address
2066 US HIGHWAY 78, TALLAPOOSA, GA 30176-1368
(770) 574-2339
Mailing address
PO BOX 67, TALLAPOOSA, GA 30176-0067

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000087997A
GA
Enumeration date
05/30/2019
Last updated
12/21/2020
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