Healthcare Provider Details

I. General information

NPI: 1154415214
Provider Name (Legal Business Name): PRICE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 HIGHWAY 136
TRENTON GA
30752-2908
US

IV. Provider business mailing address

PO BOX 99
TRENTON GA
30752-0099
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-4061
  • Fax: 706-657-7676
Mailing address:
  • Phone: 706-657-4061
  • Fax: 706-657-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE005292
License Number StateGA

VIII. Authorized Official

Name: JINNA BROWN
Title or Position: MANAGER
Credential:
Phone: 706-866-8475