Healthcare Provider Details

I. General information

NPI: 1295098762
Provider Name (Legal Business Name): BARNES DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S PATTERSON ST
VALDOSTA GA
31601-5621
US

IV. Provider business mailing address

PO BOX 1187
VALDOSTA GA
31603-1187
US

V. Phone/Fax

Practice location:
  • Phone: 229-245-6039
  • Fax: 888-276-7881
Mailing address:
  • Phone: 229-245-6039
  • Fax: 888-276-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLIE BARNES IV
Title or Position: OWNER/CEO
Credential:
Phone: 229-245-6039