Healthcare Provider Details

I. General information

NPI: 1972539443
Provider Name (Legal Business Name): EAGLE PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 E WINTHROPE AVE
MILLEN GA
30442-1840
US

IV. Provider business mailing address

936 E WINTHROPE AVE
MILLEN GA
30442-1840
US

V. Phone/Fax

Practice location:
  • Phone: 478-982-7979
  • Fax: 478-982-1010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008924
License Number StateGA

VIII. Authorized Official

Name: KENNETH DELAY
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 478-982-7979