Provider Demographics
NPI:1033291828
Name:MURRAY DRUG CO
Entity Type:Organization
Organization Name:MURRAY DRUG CO
Other - Org Name:ACME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-487-5327
Mailing Address - Street 1:18 E DAME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2201
Mailing Address - Country:US
Mailing Address - Phone:912-487-5327
Mailing Address - Fax:912-487-3581
Practice Address - Street 1:18 E DAME AVE
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2201
Practice Address - Country:US
Practice Address - Phone:912-487-5327
Practice Address - Fax:912-487-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0061173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000261841AMedicaid
2012447OtherPK
GA000261841AMedicaid