Provider Demographics
NPI:1023182490
Name:MJ PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:MJ PHARMACY SERVICES INC
Other - Org Name:HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGALLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-986-4827
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-1388
Mailing Address - Country:US
Mailing Address - Phone:478-986-4827
Mailing Address - Fax:478-986-4828
Practice Address - Street 1:236 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032
Practice Address - Country:US
Practice Address - Phone:478-986-4827
Practice Address - Fax:478-986-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE080003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00714744AMedicaid
1142796OtherOTHER ID NUMBER-COMMERCIAL NUMBER
GABM4949838OtherDEA #
GA1108710001Medicare NSC
GA511G870009Medicare PIN