Organization
QUINATE PHARMACY LLC
Active
Other names
Southern Hometown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY LEAVITT (MANAGING PARTNER)
(912) 509-3330
Entity
Organization
Contact information
Practice address
546 W BACON ST, PEMBROKE, GA 31321-4648
(912) 653-1000
(912) 295-4667
Mailing address
1557 POOLER PKWY STE 400, POOLER, GA 31322-4389
(912) 653-1000
(912) 295-4667
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHRE010656
GEORGIA BOARD OF PHARMACY
GA
Enumeration date
08/21/2018
Last updated
05/27/2020
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