=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497867337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MEDICINE CABINET OF BRUNSWICK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 03/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 STARLING ST STE 102
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31520-4265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-265-7000
-----------------------------------------------------
Fax | 912-265-1499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 STARLING ST STE 102
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31520-4265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-265-7000
-----------------------------------------------------
Fax | 912-265-1499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JON SCOTT MEEKS
-----------------------------------------------------
Credential | R.PH
-----------------------------------------------------
Telephone | 912-381-8111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE009054
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------