MEDICARE: MCCAYSVILLE DRUG CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1336979996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCAYSVILLE DRUG CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 338
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-0338
Country	:	US
Telephone Number	:	706-492-4126
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 BLUE RIDGE DR
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-2767
Country	:	US
Telephone Number	:	706-492-4126
Fax Number	:	706-492-5902

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOUSTON L ROGERS
Credential	:
Telephone Number	:	706-492-4126

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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