MEDICARE: MIMBS DRUG CO.

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	PHRE007240	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHRE007240	OTHER	GU	STATE LISC NO
2	1136236	OTHER	GA	NCPDP #

General Provider Information

NPI Number	:	1538146113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMBS DRUG CO.

Provider Business Mailing Address
First Line	:	2415-F OLD CORNELIA HIGHWAY
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30507
Country	:	US
Telephone Number	:	770-287-3662
Fax Number	:	770-287-0779

Provider Business Practice Location Address
First Line	:	2415-F OLD CORNELIA HIGHWAY
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30507-6901
Country	:	US
Telephone Number	:	770-287-3662
Fax Number	:	770-287-0779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDDIE H MIMBS
Credential	:	RPH
Telephone Number	:	770-287-3662

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	03/07/2023

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Directions to “MIMBS DRUG CO. ” Practice Location

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