Organization
OLDE TIME PHARMACY INC
Active
Other names
OLDE TIME PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD NOELL RPH (PRESIDENT)
(770) 313-7615
Entity
Organization
Contact information
Practice address
402 ARGONNE TERRACE, SUITE 230, HOLLY SPRINGS, GA 30115
(770) 783-0483
(770) 881-7910
Mailing address
145 HIGHLANDS DR, WOODSTOCK, GA 30188-6052
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
3336C0003X
Community/Retail Pharmacy
PHRE009088
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1155084
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/26/2006
Last updated
09/11/2025
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