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NPI Code Detail

MEDICARE: SANDERSVILLE DRUG CO., LLC

MEDICARE: SANDERSVILLE DRUG CO., LLC
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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1710411327
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDERSVILLE DRUG CO., LLC
Provider Business Mailing Address
First Line : PO BOX 6000
Second Line :
City : SANDERSVILLE
State : GA
Zip : 31082-6000
Country : US
Telephone Number : 478-232-0998
Fax Number :
Provider Business Practice Location Address
First Line : 528 SPARTA RD
Second Line :
City : SANDERSVILLE
State : GA
Zip : 31082-1859
Country : US
Telephone Number : 478-232-0998
Fax Number :
Authorized Official
Title or Position : OWNER/PHARMACIST
Name : MRS. LISA G. MCDONALD
Credential : RPH
Telephone Number : 478-232-0998
Provider Enumeration Date : 04/20/2017
Last Update Date : 04/20/2017

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Directions to “SANDERSVILLE DRUG CO., LLC ” Practice Location

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