Organization
SANTA FE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL LOZANO (DIRECTOR)
(770) 495-7942
Entity
Organization
Contact information
Practice address
3750 VENTURE DR, STE 140, DULUTH, GA 30096-1808
(770) 495-7942
(770) 495-7943
Mailing address
3750 VENTURE DR, STE 140, DULUTH, GA 30096-1808
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009404
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156480
OTHER ID NUMBER
—
Enumeration date
11/01/2007
Last updated
02/04/2008
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