Organization
GO PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENTON BLAKE BYRD (CEO)
(910) 646-6614
Entity
Organization
Contact information
Practice address
203 CHAUNCEY TOWN RD, SUITE B, LAKE WACCAMAW, NC 28450-2003
(910) 646-6614
(910) 646-6615
Mailing address
PO BOX 479, LAKE WACCAMAW, NC 28450-0479
(910) 646-6614
(910) 646-6615
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
11191
NC
Other
Enumeration date
12/18/2012
Last updated
12/18/2012
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