MEDICARE: SOUTH ALBANY 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
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1861167298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ALBANY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 72148
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31708-2148
Country	:	US
Telephone Number	:	229-435-4571
Fax Number	:	229-435-7069

Provider Business Practice Location Address
First Line	:	2111 BEMISS RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1940
Country	:	US
Telephone Number	:	229-588-4835
Fax Number	:	229-588-4840

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	THOMAS SHARPE
Credential	:
Telephone Number	:	229-435-4571

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	03/29/2024

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