MEDICARE: UNADILLA DRUG COMPANY, 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

General Provider Information

NPI Number	:	1164158895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNADILLA DRUG COMPANY, INC

Provider Business Mailing Address
First Line	:	101 S 3RD ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1511
Country	:	US
Telephone Number	:	229-268-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S 3RD ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1511
Country	:	US
Telephone Number	:	229-268-2111
Fax Number	:	229-268-2117

Authorized Official
Title or Position	:	CEO
Name	:	DHARA PATEL
Credential	:
Telephone Number	:	478-922-2067

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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Directions to “UNADILLA DRUG COMPANY, INC ” Practice Location

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