Organization
MORTAR AND PESTLE, LLC
Active
Other names
The Medicine Cabinet
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN MEEKS (OWNER)
(706) 298-2714
Entity
Organization
Contact information
Practice address
300 MOOTY BRIDGE ROAD, LAGRANGE, GA 30240
(706) 225-4930
(706) 298-4931
Mailing address
300 MOOTY BRIDGE ROAD, LAGRANGE, GA 30240
(706) 298-4930
(706) 298-4931
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009864
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003128157A
—
GA
01
—
2136600
PK
—
Enumeration date
07/16/2012
Last updated
07/15/2020
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