1437730934 NPI number — VILLAGE DRUG SHOP OF ATHENS INC

Table of content: (NPI 1437730934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437730934 NPI number — VILLAGE DRUG SHOP OF ATHENS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE DRUG SHOP OF ATHENS 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:
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:
1437730934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 PRINCE AVE STE 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-548-4444
Provider Business Mailing Address Fax Number:
706-548-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 PRINCE AVE STE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-548-4444
Provider Business Practice Location Address Fax Number:
706-548-2193
Provider Enumeration Date:
04/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THURMOND
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
RYAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-548-4444

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHRE003245 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000303509A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".