Individual
PHILLIP DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1308 S HARRIS ST, SANDERSVILLE, GA 31082-6913
(478) 552-1988
Mailing address
2908 OLD US 1, WADLEY, GA 30477-4010
(706) 955-5029
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
025361
GA
Other
Enumeration date
04/18/2022
Last updated
04/18/2022
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