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General NPI Number Information
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NPI Number | 1730124587
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Entity Type | Organization
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Legal Business Name | MCRAES PHARMACY OF DOUGLAS INC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 1002 WARD ST W
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City | DOUGLAS
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State | GA
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Zip | 31533-2251
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Country | US
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Telephone | 912-384-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 WARD ST W
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City | DOUGLAS
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State | GA
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Zip | 31533-2251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHAR-OWNER
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Name | DR. JAMES ANDREW HOLT
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Credential | PHARM D
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Telephone | 912-384-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH028222
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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 | PHRE003365
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License Number State | GA
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