Organization
LEE GOODRUM PHARMACY INC
Active
Other names
LEE GOODRUM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GOODRUM BS PHARMACY (CEO)
(770) 253-1121
Entity
Organization
Contact information
Practice address
40 HOSPITAL RD, NEWNAN, GA 30263-1201
(770) 253-1121
(770) 253-3572
Mailing address
40 HOSPITAL RD, NEWNAN, GA 30263-1201
(770) 253-1121
(770) 253-3572
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006304
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00285051A
—
GA
01
—
2014853
PK
—
Enumeration date
07/22/2006
Last updated
04/25/2016
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