Organization
CHICHESTERS INGLESIDE
Active
Other names
CHICHESTERS INGLESIDE
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY WRIGHT (OWNER)
(478) 746-9608
Entity
Organization
Contact information
Practice address
3051 VINEVILLE AVE, MACON, GA 31204-2460
(478) 746-9608
(478) 742-6437
Mailing address
3051 VINEVILLE AVE, MACON, GA 31204-2460
(478) 746-9608
(478) 742-6437
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE000280
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023207A
—
GA
01
—
1111638
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/05/2007
Last updated
01/28/2010
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