Organization
MAXWELL HOUSE PHARMACY LLC
Active
Other names
Maxwell House Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH MATTHEWS (OWNER)
(803) 637-5757
Entity
Organization
Contact information
Practice address
1002 GREENE ST, AUGUSTA, GA 30901-2251
(706) 722-4695
(706) 722-4696
Mailing address
1002 GREENE ST, AUGUSTA, GA 30901-2251
(706) 722-4695
(706) 722-4696
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE002600
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1100053
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
03/23/2011
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