1306980008 NPI number — CONSULTANTS' PHARMACY

Table of content: (NPI 1306980008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306980008 NPI number — CONSULTANTS' PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS' PHARMACY
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:
CHICHESTERS INSTITUTIONAL PHARMACY
Provider Other Organization Name Type Code:
3
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:
1306980008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 OCMULGEE SPRINGS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-731-2185
Provider Business Mailing Address Fax Number:
478-746-6294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 PATROL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORSYTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31029-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-741-3732
Provider Business Practice Location Address Fax Number:
478-746-6294
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASSEY
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
478-731-2185

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHRE010416 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE010416 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHRE008503 , 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: 2155649 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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