Provider Demographics
NPI:1093911000
Name:GLORIA E MACHALK
Entity Type:Organization
Organization Name:GLORIA E MACHALK
Other - Org Name:LOUISVILLE DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACHALK
Authorized Official - Suffix:
Authorized Official - Credentials:RPHN
Authorized Official - Phone:478-625-7575
Mailing Address - Street 1:112 EAST BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1620
Mailing Address - Country:US
Mailing Address - Phone:478-625-7575
Mailing Address - Fax:478-625-7638
Practice Address - Street 1:112 EAST BROAD ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1620
Practice Address - Country:US
Practice Address - Phone:478-625-7575
Practice Address - Fax:478-625-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000357607BMedicaid
GA000357607BMedicaid