Healthcare Provider Details

I. General information

NPI: 1881420651
Provider Name (Legal Business Name): MCRAE DRUG COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S SECOND AVE
MC RAE GA
31055-4659
US

IV. Provider business mailing address

121 N LEE ST
QUITMAN GA
31643-2123
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-6735
  • Fax:
Mailing address:
  • Phone: 229-263-4061
  • Fax: 229-263-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEXANDRA THOMPSON
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 229-891-8455