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General NPI Number Information
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NPI Number | 1225143464
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Entity Type | Organization
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Legal Business Name | 1ST AMERICA DRUGS
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 212 NORTHSIDE DR
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City | VALDOSTA
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State | GA
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Zip | 31602-1858
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Country | US
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Telephone | 229-242-3060
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Fax | 229-316-1366
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Provider Business Mailing Address
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Address Line | 212 NORTHSIDE DR
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City | VALDOSTA
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State | GA
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Zip | 31602-1858
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Country | US
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Telephone | 229-242-3060
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Fax | 229-316-1366
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. MICHAEL SUTTLES HICKS
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Credential | R.PH.
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Telephone | 229-242-3060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE006491
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License Number State | GA
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