1518038025 NPI number — DISCOUNT DRUGS OF ELIJAY,INC.

Table of content: (NPI 1518038025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518038025 NPI number — DISCOUNT DRUGS OF ELIJAY,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOUNT DRUGS OF ELIJAY,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:
1518038025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 PROFESSIONAL BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-217-2700
Provider Business Mailing Address Fax Number:
706-278-8071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 PROFESSIONAL BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-217-2700
Provider Business Practice Location Address Fax Number:
706-278-8071
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELLISON
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER-PHARMACIST
Authorized Official Telephone Number:
706-217-2700

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  007755 , 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: 0003404911A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1131488 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com