Provider Demographics
NPI:1396383444
Name:SENOIA DRUG CO INC.
Entity Type:Organization
Organization Name:SENOIA DRUG CO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAZELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-876-9910
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-0280
Mailing Address - Country:US
Mailing Address - Phone:770-313-1570
Mailing Address - Fax:
Practice Address - Street 1:2080 NEWNAN CROSSING BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2558
Practice Address - Country:US
Practice Address - Phone:770-876-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENOIA DRUG CO INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy