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NPI Code Detail

MEDICARE: NURSING HOME PHARMACY LLC

MEDICARE: NURSING HOME PHARMACY 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
1333600000XPharmacy
23336L0003XLong Term Care PharmacyPHRE004071GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22012681OTHERPK

General Provider Information

NPI Number : 1780680652
Entity Type Code : Organization
Provider Name (Legal Business Name) : NURSING HOME PHARMACY LLC
Provider Business Mailing Address
First Line : 1865 BOLD SPRINGS RD NW
Second Line :
City : MONROE
State : GA
Zip : 30656-4605
Country : US
Telephone Number : 770-267-8677
Fax Number : 770-267-6462
Provider Business Practice Location Address
First Line : 1865 BOLD SPRINGS RD NW
Second Line :
City : MONROE
State : GA
Zip : 30656-4605
Country : US
Telephone Number : 770-267-8677
Fax Number : 770-267-6462
Authorized Official
Title or Position : PARTNER
Name : JOHN GLEATON
Credential : BS PHARMACY
Telephone Number : 770-267-8677
Provider Enumeration Date : 06/24/2005
Last Update Date : 08/02/2016

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Directions to “NURSING HOME PHARMACY LLC ” Practice Location

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