Organization
OLDE TIME PHARMACY INC
Active
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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