Organization
KERRY LOUIS WILSON
Active
Other names
CHATUGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI WILSON BBA (CO-OWNER)
(706) 896-4686
Entity
Organization
Contact information
Practice address
579 N MAIN ST, HIAWASSEE, GA 30546-2219
(706) 896-4686
(706) 896-2325
Mailing address
579 N MAIN ST, PO BOX 385, HIAWASSEE, GA 30546-2219
(706) 896-4686
(706) 896-2325
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
007904
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00679522A
—
GA
05
—
0116483
—
NC
01
—
2019162
PK
—
Enumeration date
12/01/2006
Last updated
06/18/2015
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