Healthcare Provider Details

I. General information

NPI: 1144308552
Provider Name (Legal Business Name): CHANCY DRUGS HAHIRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST
HAHIRA GA
31632-1121
US

IV. Provider business mailing address

205 E MAIN ST
HAHIRA GA
31632-1121
US

V. Phone/Fax

Practice location:
  • Phone: 229-794-2750
  • Fax: 229-794-4092
Mailing address:
  • Phone: 229-794-2750
  • Fax: 229-794-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE003128
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BETH ROUNTREE
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 229-794-2750