Provider Demographics
NPI:1881024479
Name:CAMP CREEK VILLAGE PHARMACY INC.
Entity Type:Organization
Organization Name:CAMP CREEK VILLAGE PHARMACY INC.
Other - Org Name:BUTNER VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENWIN
Authorized Official - Middle Name:CH
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-228-0238
Mailing Address - Street 1:400 REXHAM WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7994
Mailing Address - Country:US
Mailing Address - Phone:404-228-0238
Mailing Address - Fax:404-500-4111
Practice Address - Street 1:3220 BUTNER RD SW SUITE #130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331
Practice Address - Country:US
Practice Address - Phone:404-228-0238
Practice Address - Fax:404-500-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0099713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy