Healthcare Provider Details

I. General information

NPI: 1679056584
Provider Name (Legal Business Name): HEPHZIBAH DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 WINDSOR SPRING RD
HEPHZIBAH GA
30815-4848
US

IV. Provider business mailing address

PO BOX 265
HEPHZIBAH GA
30815-0265
US

V. Phone/Fax

Practice location:
  • Phone: 706-592-4646
  • Fax: 706-592-4618
Mailing address:
  • Phone: 706-592-4646
  • Fax: 706-592-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010651
License Number StateGA

VIII. Authorized Official

Name: SONYA FLAKES PADGETT
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 706-592-4646