Provider Demographics
NPI:1578861431
Name:GEORGIA SOUTHERN UNIVERSITY HEALTH SERVICES PHARMACY
Entity Type:Organization
Organization Name:GEORGIA SOUTHERN UNIVERSITY HEALTH SERVICES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:E
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:912-478-7288
Mailing Address - Street 1:984 PLANT DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30460-0001
Mailing Address - Country:US
Mailing Address - Phone:912-478-5780
Mailing Address - Fax:912-478-8523
Practice Address - Street 1:984 PLANT DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30460-0001
Practice Address - Country:US
Practice Address - Phone:912-478-5780
Practice Address - Fax:912-478-8523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA SOUTHERN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-02
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy