Organization
WHITLOCK PHARMACY INC
Active
Other names
SHAW PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY SHAW PHARMD (OWNER PHCST)
(770) 427-5647
Entity
Organization
Contact information
Practice address
3880 DUE WEST RD NW, SUITE E, MARIETTA, GA 30064-1058
(770) 427-5647
(770) 514-7861
Mailing address
3880 DUE WEST RD NW, SUITE E, MARIETTA, GA 30064-1058
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006953
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00430097A
—
GA
01
—
1132935
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/13/2006
Last updated
03/25/2009
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