Organization
TERESE INC
Active
Other names
PEACH ORCHARD DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
TERESE FORDHAM (OWNER, PRESIDENT)
(706) 533-3369
Entity
Organization
Contact information
Practice address
2529 PEACH ORCHARD RD, AUGUSTA, GA 30906-2412
(706) 798-3253
(706) 798-3225
Mailing address
2529 PEACH ORCHARD RD, AUGUSTA, GA 30906-2412
(706) 798-3253
(706) 798-3225
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009010
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016259
PK
—
05
—
787683075A
—
GA
Enumeration date
07/30/2006
Last updated
02/16/2015
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