Individual
EBONY STORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 767-2673
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 767-2673
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
330101051156048
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330101051156048
MILITARY CIVILIAN
GA
Enumeration date
11/04/2014
Last updated
11/04/2014
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