Organization
BUTLER LONG TERM CARE SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JOHNNY BAZEMORE PHARM D (RPH/OWNER)
(478) 862-5655
Entity
Organization
Contact information
Practice address
10 B NORTH POPLAR ST, BUTLER, GA 31006
(478) 862-5655
(478) 862-2811
Mailing address
PO BOX 546, BUTLER, GA 31006-0546
(478) 862-5655
(478) 862-2811
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHRE010310
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000793295A,B,C
—
GA
01
—
FLU372
MEDICARE FLU SUBMITTER ID
GA
Enumeration date
10/20/2016
Last updated
10/20/2016
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