Healthcare Provider Details

I. General information

NPI: 1609926500
Provider Name (Legal Business Name): OCILLA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N IRWIN AVE
OCILLA GA
31774-5007
US

IV. Provider business mailing address

515 N IRWIN AVE
OCILLA GA
31774-5007
US

V. Phone/Fax

Practice location:
  • Phone: 229-468-5929
  • Fax: 229-468-7313
Mailing address:
  • Phone: 229-468-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE003436
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHRE003436
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE003436
License Number StateGA

VIII. Authorized Official

Name: JOHN D PRICE
Title or Position: PHARMACIST/OWNER
Credential: PHARMD
Phone: 229-468-5929