Organization
GEORGIA PHARMACY VENTURES LLC
Active
Other names
MAGNOLIA MANOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEE RPH (PRESIDENT)
(478) 783-4262
Entity
Organization
Contact information
Practice address
342 INDUSTRIAL BLVD, STE C, HAWKINSVILLE, GA 31036-2103
(478) 783-4262
(478) 783-8970
Mailing address
PO BOX 998, HAWKINSVILLE, GA 31036-0998
(478) 783-4262
(478) 783-8970
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE009471
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017405
PK
—
Enumeration date
04/01/2008
Last updated
09/28/2016
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