Healthcare Provider Details

I. General information

NPI: 1083523294
Provider Name (Legal Business Name): UNIONVILLE DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 PIO NONO AVE
MACON GA
31204-4633
US

IV. Provider business mailing address

1377 PIO NONO AVE
MACON GA
31204-4633
US

V. Phone/Fax

Practice location:
  • Phone: 478-746-8331
  • Fax: 478-742-1428
Mailing address:
  • Phone: 478-746-8331
  • Fax: 478-742-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL OGBENNA ITEOGU
Title or Position: OWNER
Credential: PHARM.D.
Phone: 478-957-3370