Healthcare Provider Details

I. General information

NPI: 1831260488
Provider Name (Legal Business Name): MONROE DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S MIDLAND AVE
MONROE GA
30655-1629
US

IV. Provider business mailing address

PO BOX 1006
MONROE GA
30655-1006
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-2530
  • Fax:
Mailing address:
  • Phone: 770-267-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE002761
License Number StateGA

VIII. Authorized Official

Name: MS. DEANNA HAMBY GREEN
Title or Position: ATTORNEY/CFO
Credential: J.D.
Phone: 770-267-2530