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General NPI Number Information
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NPI Number | 1558301069
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Entity Type | Organization
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Legal Business Name | BLACKSHEAR DRUG CO
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3487 US HIGHWAY 84
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City | BLACKSHEAR
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State | GA
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Zip | 31516-2293
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Country | US
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Telephone | 912-449-6616
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Fax | 912-449-5759
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Provider Business Mailing Address
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Address Line | 3487 US HIGHWAY 84
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City | BLACKSHEAR
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State | GA
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Zip | 31516-2293
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Country | US
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Telephone | 912-449-6616
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Fax | 912-449-5759
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Authorized Official
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Title or Position | OWNER / PIC
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Name | MR. JAMES CAREY MARTIN III
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Credential | RPH
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Telephone | 912-449-6616
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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 | PHRE009509
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License Number State | GA
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