Healthcare Provider Details

I. General information

NPI: 1073582920
Provider Name (Legal Business Name): CLINIC DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E FORSYTH ST
AMERICUS GA
31709-3721
US

IV. Provider business mailing address

1001 E FORSYTH ST PO BOX 445
AMERICUS GA
31709-3721
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-2783
  • Fax: 229-924-9220
Mailing address:
  • Phone: 229-924-2783
  • Fax: 229-924-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number003303
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. LEE FOUCHE' PINNELL
Title or Position: CO-OWNER
Credential: PHARM.D.
Phone: 229-924-2783