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Organization

GEORGIA STATE PRISON REGIONAL PHARMACY

Active
Parent organization
GEORGIA DEPARTMENT OF CORRECTIONS
Organization subpart
Yes

Provider details

NPI number
Legal business name
GEORGIA DEPARTMENT OF CORRECTIONS
Authorized official
MR. BENJAMIN CLARK (PHARMACY DIRECTOR)
(912) 557-7960
Entity
Organization

Contact information

Practice address
300 1ST AVE S, REIDSVILLE, GA 30453-9304
(912) 557-7960
(912) 557-7975
Mailing address
300 1ST AVE S, REIDSVILLE, GA 30453-9304
(912) 557-7960
(912) 557-7975

Taxonomy

Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PHH005792
GA

Other

Enumeration date
05/23/2018
Last updated
05/23/2018
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