Provider Demographics
NPI:1023192838
Name:NORTH COLUMBUS PHARMACY OF COLUMBUS, GEORGIA, INC.
Entity Type:Organization
Organization Name:NORTH COLUMBUS PHARMACY OF COLUMBUS, GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PLC
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-327-5125
Mailing Address - Street 1:6490 VETERANS PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-327-5125
Mailing Address - Fax:706-327-4815
Practice Address - Street 1:6490 VETERANS PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-327-5125
Practice Address - Fax:706-327-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0066273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006627OtherSTATE PHARMACY LICENSE
GA00735039AMedicaid
GA1108201OtherNCPDP NUMBER
GA1108201OtherNCPDP NUMBER