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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