Individual
MR. JACK EDWARD FUNDERBURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 6TH ST SE, MOULTRIE, GA 31768-4842
(229) 984-1378
(229) 890-3185
Mailing address
305 6TH ST SE, MOULTRIE, GA 31768-4842
(229) 984-1378
(229) 890-3185
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH010666
GA
Other
Enumeration date
04/18/2011
Last updated
04/18/2011
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