Provider Demographics
NPI:1689757916
Name:LAKE OCONEE PHARMACY & COMPOUNDING CENTER
Entity Type:Organization
Organization Name:LAKE OCONEE PHARMACY & COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GRIFFIN
Authorized Official - Last Name:MARQUESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD,CDE,CDM
Authorized Official - Phone:706-485-4990
Mailing Address - Street 1:1124 GREENSBORO RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5549
Mailing Address - Country:US
Mailing Address - Phone:706-485-4990
Mailing Address - Fax:706-485-4737
Practice Address - Street 1:1124 GREENSBORO RD
Practice Address - Street 2:SUITE 104
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5549
Practice Address - Country:US
Practice Address - Phone:706-485-4990
Practice Address - Fax:706-485-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0090493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy