Provider Demographics
NPI:1366576001
Name:EAGLE'S LANDING PHARMACY II
Entity type:Organization
Organization Name:EAGLE'S LANDING PHARMACY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RINK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-957-5556
Mailing Address - Street 1:3758 HIGHWAY 42
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3653
Mailing Address - Country:US
Mailing Address - Phone:770-957-5556
Mailing Address - Fax:770-957-1906
Practice Address - Street 1:3758 HIGHWAY 42
Practice Address - Street 2:SUITE 201
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3653
Practice Address - Country:US
Practice Address - Phone:770-957-5556
Practice Address - Fax:770-957-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0081103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy