Organization
PONCE INFECTIOUS DISEASE CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALAURA D. HALLMAN RPH (DIRECTOR OF PHARMACY)
(404) 616-3576
Entity
Organization
Contact information
Practice address
341 PONCE DE LEON AVE NE, ATLANTA, GA 30308-2012
(404) 616-9783
Mailing address
80 JESSE HILL JR DR SE, PO BOX 26041, ATLANTA, GA 30303-3031
(404) 616-3576
(404) 616-6070
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
855C
—
GA
01
—
GA 7146
PHARMACY LICENSE
GA
Enumeration date
03/15/2007
Last updated
08/22/2020
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