MEDICARE: MOUNT VERNON DRUG COMPANY

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	183500000X	Pharmacist	005037	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

General Provider Information

NPI Number	:	1194868539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT VERNON DRUG COMPANY

Provider Business Mailing Address
First Line	:	PO BOX 195
Second Line	:	421 S RAILROAD AVENUE
City	:	MOUNT VERNON
State	:	GA
Zip	:	30445-0195
Country	:	US
Telephone Number	:	912-583-2216
Fax Number	:	912-583-2217

Provider Business Practice Location Address
First Line	:	421 S RAILROAD AVE
Second Line	:
City	:	MOUNT VERNON
State	:	GA
Zip	:	30445-0195
Country	:	US
Telephone Number	:	912-583-2216
Fax Number	:	912-583-2217

Authorized Official
Title or Position	:	OWNER REGISTERED PHARMACIST
Name	:	MR. EDWARD DARRELL SAMMONS
Credential	:
Telephone Number	:	912-583-2216

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/07/2008

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Directions to “MOUNT VERNON DRUG COMPANY ” Practice Location

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