Organization
SOUTHEASTERN PHARMACY LLC
Active
Other names
ALTAMA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE MICHAEL LEWIS (OWNER)
(912) 264-2622
Entity
Organization
Contact information
Practice address
5711 ALTAMA AVE, UNIT G, BRUNSWICK, GA 31525-2240
(912) 264-2622
(912) 264-1392
Mailing address
5711 ALTAMA AVE, SUITE G, BRUNSWICK, GA 31525-2240
(912) 264-2622
(912) 264-1392
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
002733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000028256A
—
GA
01
—
1106930
NABP
GA
05
—
1106930
—
GA
Enumeration date
07/14/2006
Last updated
02/17/2020
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