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MR. CHARLES IVERSON STOREY RPH

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1821278441

Individual Registrant:
MR. CHARLES IVERSON STOREY RPH
Gender: M
Not Sole Proprietor

Location and contact information for practice:
145 N MAIN AVE  PINE MOUNTAIN, GA 31822-2454 US
Tel: 706-663-2255  Fax: 706-663-8026

Contact information for business:
PO BOX A  PINE MOUNTAIN, GA 31822-0500 US
Tel: 706-663-2255  Fax: 706-663-8026

Registration Information:
NPI: 1821278441
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
GARPH010218

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE PHARMACIST LICENSERPH010218GA01




HEALTH CARE JOBS GA - Page 1



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