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NPI Code Detail

MEDICARE: EGOR ENTERPRISES, INC

MEDICARE: EGOR ENTERPRISES, 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
13336C0003XCommunity/Retail PharmacyPHRE008937GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PHRE008937OTHERGASTATE PHARMACY LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871570275
Entity Type Code : Organization
Provider Name (Legal Business Name) : EGOR ENTERPRISES, INC
Provider Business Mailing Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2507
Fax Number : 706-277-2536
Provider Business Practice Location Address
First Line : 1100 E WALNUT AVE
Second Line :
City : DALTON
State : GA
Zip : 30721-4183
Country : US
Telephone Number : 706-226-6000
Fax Number : 706-226-3786
Authorized Official
Title or Position : PHARMACIST OWNER
Name : MR. TRACEY DAILEY
Credential : RPH
Telephone Number : 706-277-2507
Provider Enumeration Date : 12/27/2005
Last Update Date : 03/07/2023

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Directions to “EGOR ENTERPRISES, INC ” Practice Location

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