Organization
CHICKAMAUGA DRUG STORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP TALLEY (CHIEF MANAGER)
(706) 375-2611
Entity
Organization
Contact information
Practice address
114 COVE RD, CHICKAMAUGA, GA 30707-1407
(706) 375-2611
(706) 375-6219
Mailing address
114 COVE RD, CHICKAMAUGA, GA 30707-1407
(706) 375-2611
(706) 375-6219
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE005365
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00024582A
—
GA
Enumeration date
02/15/2007
Last updated
08/13/2010
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