Healthcare Provider Details

I. General information

NPI: 1639156219
Provider Name (Legal Business Name): MIMBS DRUG CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251-H WINDER HWY
FLOWERY BRANCH GA
30542-4623
US

IV. Provider business mailing address

4251-H WINDER HWY
FLOWERY BRANCH GA
30542-4623
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-9101
  • Fax: 770-965-9658
Mailing address:
  • Phone: 770-965-9101
  • Fax: 770-965-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008007
License Number StateGA

VIII. Authorized Official

Name: MR. EDDIE H MIMBS
Title or Position: PRESIDENT
Credential: RPH
Phone: 770-965-9101