Healthcare Provider Details

I. General information

NPI: 1992720221
Provider Name (Legal Business Name): MADDENS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLLEGE AVE
ELBERTON GA
30635-1705
US

IV. Provider business mailing address

101 COLLEGE AVE
ELBERTON GA
30635-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-1701
  • Fax: 706-283-1704
Mailing address:
  • Phone: 706-283-1701
  • Fax: 706-283-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006766
License Number StateGA

VIII. Authorized Official

Name: DONALD JOSEPH PIELA JR.
Title or Position: PRESIDENT/PHARMACIST IN CHARGE
Credential:
Phone: 706-283-1701