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General NPI Number Information
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NPI Number | 1467439760
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Entity Type | Organization
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Legal Business Name | MIMBS DRUG CO DBA DIXIE CITY PHARMACY # 2
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4222 MCEVER RD
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City | OAKWOOD
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State | GA
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Zip | 30566-2237
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Country | US
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Telephone | 770-536-1099
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Fax | 770-536-0577
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Provider Business Mailing Address
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Address Line | 4222 MCEVER RD
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City | OAKWOOD
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State | GA
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Zip | 30566-2237
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Country | US
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Telephone | 770-536-1099
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Fax | 770-536-0577
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDDIE H MIMBS
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Credential | RPH
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Telephone | 770-536-3329
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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 | PHRE006004
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License Number State | GA
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