1073558359 NPI number — ECONOMY DRUG CO. OF ALBANY

Table of content: (NPI 1073558359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073558359 NPI number — ECONOMY DRUG CO. OF ALBANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECONOMY DRUG CO. OF ALBANY
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:
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:
1073558359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 N WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31701-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-435-5434
Provider Business Mailing Address Fax Number:
229-432-9019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31701-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-435-5434
Provider Business Practice Location Address Fax Number:
229-432-9019
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
229-435-5434

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE006670 , 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: 1101916 . This is a "NABP OR NCPDP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00027277A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00027277B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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