Healthcare Provider Details

I. General information

NPI: 1437240397
Provider Name (Legal Business Name): ROYSTON DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FRANKLIN SPRINGS ST
ROYSTON GA
30662-4109
US

IV. Provider business mailing address

26 FRANKLIN SPRINGS ST
ROYSTON GA
30662-4109
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-7223
  • Fax: 706-245-6727
Mailing address:
  • Phone: 706-245-7223
  • Fax: 706-245-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE004096
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTY B PHILLIPS-MALCOM
Title or Position: CEO/OWNER
Credential: R.PH
Phone: 706-245-7223