Provider Demographics
NPI:1033224068
Name:GEORGETOWN DRUG, LLC
Entity Type:Organization
Organization Name:GEORGETOWN DRUG, LLC
Other - Org Name:GEORGETOWN DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-670-1886
Mailing Address - Street 1:1080 KING GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1080 KING GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9569
Practice Address - Country:US
Practice Address - Phone:912-920-1500
Practice Address - Fax:912-920-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8390333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00861231AMedicaid
1146895OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1146895OtherOTHER ID NUMBER-COMMERCIAL NUMBER
GA00861231AMedicaid
GA1312250001Medicare NSC