Organization
PINE MOUNTAIN PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES IVERSON STOREY III RPH (PRESIDENT OWNER)
(706) 663-2255
Entity
Organization
Contact information
Practice address
145 N MAIN AVE, PINE MOUNTAIN, GA 31822-0500
(706) 663-2255
Mailing address
PO BOX A, 145 N MAIN AVE, PINE MOUNTAIN, GA 31822-0500
(706) 663-2255
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
158
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1112969
NABP
GA
Enumeration date
07/04/2006
Last updated
08/22/2020
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