Organization
KENNESTONE HOSPITAL, INC
Active
Other names
WellStar Pharmacy Network
Organization subpart
No
Provider details
NPI number
Authorized official
EBENEZER ERZUAH (EXEC DIRECTOR REIMBURSEMENT)
(470) 956-4981
Entity
Organization
Contact information
Practice address
3950 AUSTELL RD, SUITE 8, AUSTELL, GA 30106-1121
(470) 732-2111
(678) 495-8798
Mailing address
PO BOX 741705, ATLANTA, GA 30374-1705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112057A
—
GA
01
—
2129620
PK
—
Enumeration date
03/21/2011
Last updated
05/06/2020
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