Healthcare Provider Details

I. General information

NPI: 1780653568
Provider Name (Legal Business Name): OATTS DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W JACKSON ST
DUBLIN GA
31021-6116
US

IV. Provider business mailing address

P.O. BOX 537
DUBLIN GA
31040-6116
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1822
  • Fax: 478-274-9562
Mailing address:
  • Phone: 478-272-1822
  • Fax: 478-274-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE005765
License Number StateGA

VIII. Authorized Official

Name: MARK C COOPER
Title or Position: OWNER
Credential: RPH
Phone: 478-272-1822