MEDICARE: MEDVILLE PHARMACY AND COMPOUNDING

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

General Provider Information

NPI Number	:	1053146456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDVILLE PHARMACY AND COMPOUNDING

Provider Business Mailing Address
First Line	:	2205 E OGLETHORPE BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2939
Country	:	US
Telephone Number	:	229-500-6973
Fax Number	:	229-500-6974

Provider Business Practice Location Address
First Line	:	2205 E OGLETHORPE BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2939
Country	:	US
Telephone Number	:	229-500-6973
Fax Number	:	229-500-6974

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. GEORGE U AGUWA
Credential	:
Telephone Number	:	229-500-6973

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “MEDVILLE PHARMACY AND COMPOUNDING ” Practice Location

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