Provider Demographics
NPI:1033362314
Name:SOUTH ALBANY PHARMACY, LLC
Entity Type:Organization
Organization Name:SOUTH ALBANY PHARMACY, LLC
Other - Org Name:U SAVE IT PHARMACY SOUTH ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-345-4571
Mailing Address - Street 1:PO BOX 72148
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2148
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-435-4734
Practice Address - Street 1:1310 NEWTON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-3480
Practice Address - Country:US
Practice Address - Phone:229-435-5199
Practice Address - Fax:229-436-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0095273336C0003X, 332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA437359606AMedicaid
2117577OtherPK
2117577OtherPK
GA437359606AMedicaid