MEDICARE: MIMBS DRUG CO DBA DIXIE CITY PHARMACY # 2

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	PHRE006004	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1126867	OTHER	GA	NCPDP NUMBER
2	PHRE006004	OTHER	GA	STATE LISC #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467439760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMBS DRUG CO DBA DIXIE CITY PHARMACY # 2

Provider Business Mailing Address
First Line	:	4222 MCEVER RD
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-2237
Country	:	US
Telephone Number	:	770-536-1099
Fax Number	:	770-536-0577

Provider Business Practice Location Address
First Line	:	4222 MCEVER RD
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-2237
Country	:	US
Telephone Number	:	770-536-1099
Fax Number	:	770-536-0577

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDDIE H MIMBS
Credential	:	RPH
Telephone Number	:	770-536-3329

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/07/2023

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