Healthcare Provider Details

I. General information

NPI: 1285849836
Provider Name (Legal Business Name): COMMUNITY DISCOUNT PARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W GORDON AVE
ALBANY GA
31701-3258
US

IV. Provider business mailing address

310 W GORDON AVE
ALBANY GA
31701-3258
US

V. Phone/Fax

Practice location:
  • Phone: 229-432-7839
  • Fax: 229-434-9873
Mailing address:
  • Phone: 229-432-7839
  • Fax: 229-434-9873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006693
License Number StateGA

VIII. Authorized Official

Name: ANNIE RUTH BURNS
Title or Position: OWNER
Credential:
Phone: 229-435-4671