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General NPI Number Information
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NPI Number | 1255323788
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Entity Type | Organization
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Legal Business Name | COMMUNITY ANCILLARY SERVICES, INC.
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 342 INDUSTRIAL BLVD SUITE A
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-2106
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Country | US
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Telephone | 478-783-1515
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Fax | 478-783-1404
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Provider Business Mailing Address
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Address Line | PO BOX 997
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City | HAWKINSVILLE
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State | GA
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Zip | 31036-0997
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Country | US
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Telephone | 478-783-1515
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Fax | 478-783-1404
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. JAMES RUSTY LEE JR.
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Credential | RPH
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Telephone | 478-783-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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