MEDICARE: PORTER PHARMACY & GIFTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	005795	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033273081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER PHARMACY & GIFTS, INC.

Provider Business Mailing Address
First Line	:	134 N 2ND ST
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-6304
Country	:	US
Telephone Number	:	478-934-6344
Fax Number	:	478-934-8820

Provider Business Practice Location Address
First Line	:	134 N 2ND ST
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-6304
Country	:	US
Telephone Number	:	478-934-6344
Fax Number	:	478-934-8820

Authorized Official
Title or Position	:	STAFF PHARMACIST
Name	:	DR. ROBERT A DYKES
Credential	:	PHARM.D
Telephone Number	:	478-934-6344

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/16/2023

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Directions to “PORTER PHARMACY & GIFTS, INC. ” Practice Location

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