Healthcare Provider Details

I. General information

NPI: 1720160666
Provider Name (Legal Business Name): TRI-CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S MAIN ST
REIDSVILLE GA
30453-4602
US

IV. Provider business mailing address

PO BOX 159
REIDSVILLE GA
30453-0159
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-4701
  • Fax: 912-557-6078
Mailing address:
  • Phone: 912-557-4701
  • Fax: 912-557-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008101
License Number StateGA

VIII. Authorized Official

Name: FRANK TOOLE
Title or Position: OWNER
Credential: RPH
Phone: 912-557-4701