Organization
SLS PHARMACY INC
Active
Other names
WILLACOOCHEE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SAMMY STORY RPH (PRESIDENT)
(912) 534-5195
Entity
Organization
Contact information
Practice address
561 EAST MAIN STREET, WILLACOOCHEE, GA 31650
(912) 534-5195
(912) 534-6383
Mailing address
PO BOX 190, WILLACOOCHEE, GA 31650-0190
(912) 534-5195
(912) 534-6383
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006506
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000022844A
—
GA
Enumeration date
01/24/2007
Last updated
07/13/2011
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