Organization
HEPHZIBAH PHARMACY LLC
Active
Other names
HEPHZIBAH PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH FLAKES BS PHARMACY (OWNER)
(706) 592-4646
Entity
Organization
Contact information
Practice address
4819 WINDSOR SPRING RD, HEPHZIBAH, GA 30815-4848
(706) 592-4646
(706) 592-4618
Mailing address
PO BOX 265, HEPHZIBAH, GA 30815-0265
(706) 592-4646
(706) 592-4618
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE004580
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00037848A
—
GA
01
—
2012942
PK
—
Enumeration date
02/15/2007
Last updated
04/22/2016
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