Organization
ADVANCED MEDICAL GROUP, LLC
Active
Other names
THOMAS DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VANCE T WALL SR. RPH (CEO/PRESIDENT)
(877) 645-3506
Entity
Organization
Contact information
Practice address
118 N MAIN ST, BOSTON, GA 31626-2257
(229) 498-1018
(229) 498-1012
Mailing address
450 OLD PEACHTREE RD NW, SUITE 102, SUWANEE, GA 30024-7289
(877) 645-3506
(678) 689-1459
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHRE009897
GA
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009897
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHRE009897
RETAIL PHARMACY PERMIT
GA
Enumeration date
01/24/2013
Last updated
01/29/2013
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