Organization
SELF-MED RX CLAYTON DRUG INC
Active
Other names
CLAYTON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE ADDINGTON (PIC)
(706) 782-3211
Entity
Organization
Contact information
Practice address
100 S MAIN ST, CLAYTON, GA 30525-5480
(706) 782-3211
(706) 782-0705
Mailing address
PO BOX 686, C/O SEF MED RX, CLAYTON, GA 30525
(706) 782-3211
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE002710
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00025033A
—
GA
01
—
2012111
PK
—
Enumeration date
10/10/2006
Last updated
04/01/2016
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