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General NPI Number Information
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NPI Number | 1326110107
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Entity Type | Organization
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Legal Business Name | UNIONVILLE DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1381 PIO NONO AVE
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City | MACON
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State | GA
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Zip | 31204-4633
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Country | US
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Telephone | 478-746-2842
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Fax | 478-746-8362
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Provider Business Mailing Address
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Address Line | 1381 PIO NONO AVE
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City | MACON
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State | GA
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Zip | 31204-4633
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Country | US
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Telephone | 478-742-1448
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Fax | 478-742-1428
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MIKE ITEOGU
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Credential | PHARMD
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Telephone | 478-742-1448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 6785
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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