Organization
MONFORT DRUG AND COMPOUNDING COMPANY INC
Active
Other names
Monfort Drug and Compounding Company, INC
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEE SMITH (OWNER)
(770) 963-2438
Entity
Organization
Contact information
Practice address
470 N CLAYTON ST STE 101, LAWRENCEVILLE, GA 30046-4872
(770) 963-2438
(770) 963-0166
Mailing address
470 N CLAYTON ST, SUITE 101, LAWRENCEVILLE, GA 30046-4872
(770) 963-2438
(770) 963-0166
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE005529
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159981
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/14/2010
Last updated
09/17/2010
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