MEDICARE: CAVE SPRING 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	3336C0003X	Community/Retail Pharmacy	PHRE009047	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1154626	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1861403404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVE SPRING PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-0310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 ROME RD SW
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-2701
Country	:	US
Telephone Number	:	706-777-9950
Fax Number	:	706-777-8235

Authorized Official
Title or Position	:	OWNER
Name	:	CLYDE MUSICK
Credential	:	RPH
Telephone Number	:	706-232-3047

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/15/2011

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Directions to “CAVE SPRING PHARMACY LLC ” Practice Location

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