Organization
SUMMIT HEALTHPLEX PHARMACY INC
Active
Other names
SUMMIT HEALTHPLEX PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MATISTIC PHRM (PHRM MANG)
(404) 394-3199
Entity
Organization
Contact information
Practice address
1755 HIGHWAY 34 E, STE 1400, NEWNAN, GA 30265-5631
(770) 252-7500
(770) 254-3652
Mailing address
1755 HIGHWAY 34 E, STE 1400, NEWNAN, GA 30265-5631
(770) 252-7500
(770) 254-3652
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8497
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000921093A
—
GA
01
—
1148724
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/23/2006
Last updated
04/22/2011
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