Individual
MR. CHARLES IVERSON STOREY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
145 N MAIN AVE, PINE MOUNTAIN, GA 31822-2454
(706) 663-2255
(706) 663-8026
Mailing address
PO BOX A, PINE MOUNTAIN, GA 31822-0500
(706) 663-2255
(706) 663-8026
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH010218
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH010218
STATE PHARMACIST LICENSE
GA
Enumeration date
11/12/2007
Last updated
11/12/2007
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