NPI 1104881556
Dkl31092 INC
Practice location
- Address
- 112 S Dooly St, Montezuma, GA 31063-1604
- Phone
- (478) 472-7561
- Fax
- (478) 472-5887
- Mailing address
- PO Box 250, Montezuma, GA 31063-0250
Authorised official
- Name
- Donald Lane
- Title
- Owner
- Phone
- (478) 472-7561
Registered specialties (4)
Community/Retail Pharmacy
Primary
Durable Medical Equipment & Medical Supplies
Pharmacy
Long Term Care Pharmacy
Registry record
- NPI
- 1104881556
- Entity type
- Organization
- NPI issued
- 19 Apr 2006
- Record last updated
- 21 Apr 2010
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.