Organization
DJTR HOLDINGS INC
Active
Other names
crossroads family pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY ANN MOODY (ACCOUNTING MANAGER)
(229) 435-4571
Entity
Organization
Contact information
Practice address
7838 HIGHWAY 48, MENLO, GA 30731-6337
(706) 862-2064
(706) 862-2477
Mailing address
PO BOX 72148, ALBANY, GA 31708-2148
(229) 435-4571
(229) 435-7069
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009872
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003128088A
—
GA
05
—
143107
—
AL
01
—
2137023
PK
—
Enumeration date
09/27/2012
Last updated
03/29/2024
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