Provider Demographics
NPI:1992536148
Name:BRASSTOWN PROFESSIONAL PHARMACY, INC
Entity type:Organization
Organization Name:BRASSTOWN PROFESSIONAL PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-745-2303
Mailing Address - Street 1:23 MURPHY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3157
Mailing Address - Country:US
Mailing Address - Phone:706-745-2303
Mailing Address - Fax:706-745-2333
Practice Address - Street 1:23 MURPHY HWY STE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3157
Practice Address - Country:US
Practice Address - Phone:706-455-8123
Practice Address - Fax:706-745-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730115619OtherBRASSTOWN NPI#
1700192960OtherAMY COLE, R.PH. NPI #