Organization
MCINTOSH TRAIL CSB
Active
Other names
BHC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MCCOLLUM (EXECUTIVE DIRECTOR)
(770) 358-8251
Entity
Organization
Contact information
Practice address
1501A KALAMAZOO DR, GRIFFIN, GA 30224-3919
(770) 358-8250
(770) 229-3223
Mailing address
136 N HILL ST, GRIFFIN, GA 30223-3335
(770) 229-3000
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PHRE005229
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000251666A
—
GA
01
—
1123645
NCPDP
GA
Enumeration date
06/05/2008
Last updated
06/11/2008
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