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General NPI Number Information
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NPI Number | 1639156219
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Entity Type | Organization
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Legal Business Name | MIMBS DRUG CO.
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4251-H WINDER HWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-4623
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Country | US
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Telephone | 770-965-9101
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Fax | 770-965-9658
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Provider Business Mailing Address
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Address Line | 4251-H WINDER HWY
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-4623
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Country | US
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Telephone | 770-965-9101
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Fax | 770-965-9658
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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 | 770-965-9101
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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 | PHRE008007
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License Number State | GA
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