Organization
BROXTON PHARMACY LLC
Active
Other names
Broxton Pharmacy,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
FREDDIE PRIDGEN (OWNER)
(912) 359-2362
Entity
Organization
Contact information
Practice address
402 ALABAMA ST N, BROXTON, GA 31519-6001
(912) 359-2362
(912) 359-3607
Mailing address
402 ALABAMA ST N, BROXTON, GA 31519-6001
(912) 359-2362
(912) 359-3607
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010064
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146466
PK
—
Enumeration date
06/23/2014
Last updated
09/08/2014
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