Organization
VILLA RICA RX LLC
Active
Other names
VILLA RICA DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COLTON HAROLD BLACKMON PHARM D (OWNER)
(770) 456-4663
Entity
Organization
Contact information
Practice address
222 WEST WILSON STREET, VILLA RICA, GA 30180
(770) 456-4663
(770) 456-4661
Mailing address
222 WEST WILSON STREET, VILLA RICA, GA 30180
(770) 456-4663
(770) 456-4661
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
PHRE009763
GA
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010412
GA
Other
Enumeration date
06/09/2011
Last updated
06/26/2018
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