MEDICARE: UNION PHARMACY

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	333600000X	Pharmacy	PHRE002986	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1115179	OTHER	GA	NABP
2	PHRE002986	OTHER	GA	PHARMACY LICENCE
3	5206750	OTHER	GA	CHAIN I.D.

General Provider Information

NPI Number	:	1467506212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION PHARMACY

Provider Business Mailing Address
First Line	:	624 SIBLEY AVE
Second Line	:	P. O. BOX 303
City	:	UNION POINT
State	:	GA
Zip	:	30669-1140
Country	:	US
Telephone Number	:	706-486-2131
Fax Number	:	706-486-2132

Provider Business Practice Location Address
First Line	:	624 SIBLEY AVE
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-1140
Country	:	US
Telephone Number	:	706-486-2131
Fax Number	:	706-486-2132

Authorized Official
Title or Position	:	CEO
Name	:	JAMES CARPENTER
Credential	:	RPH
Telephone Number	:	706-486-2131

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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Directions to “UNION PHARMACY ” Practice Location

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