1053389478 NPI number — SHERWOODS DRUG SHOP INC

Table of content: (NPI 1053389478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053389478 NPI number — SHERWOODS DRUG SHOP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERWOODS DRUG SHOP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053389478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 NELSON BROGDON BLVD
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
BUFORD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30518-5400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-945-9526
Provider Business Mailing Address Fax Number:
770-945-1282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 NELSON BROGDON BLVD
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
BUFORD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-945-9526
Provider Business Practice Location Address Fax Number:
770-945-1282
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
DANICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-945-9526

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE004296 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2132297 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com