Organization
JASPER DRUG STORE AT FOOTHILLS
Active
Other names
JASPER DRUG STORE AT FOOTHILLS
Organization subpart
No
Provider details
NPI number
Authorized official
LEE DUNN (PRESIDENT)
(706) 692-5910
Entity
Organization
Contact information
Practice address
80 FOOTHILLS PKWY, MARBLE HILL, GA 30148-2255
(770) 893-3784
(770) 893-3600
Mailing address
80 FOOTHILLS PKWY, MARBLE HILL, GA 30148-2255
(770) 893-3784
(770) 893-3600
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009465
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017406
PK
—
05
—
998025657
—
GA
Enumeration date
05/22/2008
Last updated
04/10/2013
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