MEDICARE: HOGANSVILLE PHARMACY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE006611	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1123924	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184780074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGANSVILLE PHARMACY INC

Provider Business Mailing Address
First Line	:	300 E MAIN ST
Second Line	:
City	:	HOGANSVILLE
State	:	GA
Zip	:	30230-1134
Country	:	US
Telephone Number	:	706-637-8683
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E MAIN ST
Second Line	:
City	:	HOGANSVILLE
State	:	GA
Zip	:	30230-1134
Country	:	US
Telephone Number	:	706-637-8683
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHIL WALDROP
Credential	:
Telephone Number	:	706-637-8683

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/16/2012

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Directions to “HOGANSVILLE PHARMACY INC ” Practice Location

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