Organization
SOUTHEASTERN REGIONAL MEDICAL CENTER, INC.
Active
Other names
Southeastern Regional Medical Center Retail Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL WRIGHT (PRESIDENT OF PHARMACY SERVICES)
(806) 242-7782
Entity
Organization
Contact information
Practice address
600 CELEBRATE LIFE PKWY STE A176A, NEWNAN, GA 30265-8001
(770) 400-6392
(404) 348-0453
Mailing address
320 S POLK ST STE 200, AMARILLO, TX 79101-1436
(806) 242-7782
(404) 348-0453
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003195531A
—
GA
01
—
1162661
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/25/2012
Last updated
03/08/2024
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