Healthcare Provider Details

I. General information

NPI: 1316081045
Provider Name (Legal Business Name): COX PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE SE
CAIRO GA
39828-2726
US

IV. Provider business mailing address

300 2ND AVE SE
CAIRO GA
39828-2726
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-9017
  • Fax: 229-377-3994
Mailing address:
  • Phone: 229-377-9017
  • Fax: 229-377-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE006069
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY FRED COX
Title or Position: OWNER
Credential:
Phone: 229-377-9017