Organization
OLDE TIME PHARMACY AT SIXES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAD SUTHERLAND (MANAGER)
(678) 445-4486
Entity
Organization
Contact information
Practice address
684 SIXES RD, SUITE 105, HOLLY SPRINGS, GA 30115-8721
(678) 445-4486
(678) 445-3536
Mailing address
684 SIXES RD, SUITE 105, HOLLY SPRINGS, GA 30115-8721
(678) 445-4486
(678) 445-3536
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
PHRE009711
GA
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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