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NPI Code Detail

MEDICARE: PRESBYTERIAN HOME PHARMACY INC

MEDICARE: PRESBYTERIAN HOME 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
13336C0003XCommunity/Retail Pharmacy
23336L0003XLong Term Care PharmacyPHRE005010GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22017528OTHERPK

General Provider Information

NPI Number : 1760528285
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESBYTERIAN HOME PHARMACY INC
Provider Business Mailing Address
First Line : PO BOX 407
Second Line :
City : QUITMAN
State : GA
Zip : 31643-0407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1901 W SCREVEN ST
Second Line :
City : QUITMAN
State : GA
Zip : 31643-3913
Country : US
Telephone Number : 229-263-6130
Fax Number : 229-263-6169
Authorized Official
Title or Position : EXCTV DIR
Name : ALEX PATTERSON
Credential : MS
Telephone Number : 229-263-6101
Provider Enumeration Date : 01/30/2007
Last Update Date : 12/08/2020

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Directions to “PRESBYTERIAN HOME PHARMACY INC ” Practice Location

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