Provider Demographics
NPI:1114963139
Name:BMS PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:BMS PHARMACY SERVICES LLC
Other - Org Name:HABERSHAM DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAIRD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-535-8860
Mailing Address - Street 1:PO BOX 907457
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0908
Mailing Address - Country:US
Mailing Address - Phone:770-535-8860
Mailing Address - Fax:770-532-7100
Practice Address - Street 1:638 HISTORIC HWY 441 STE A
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-4128
Practice Address - Fax:706-754-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
GAPHRE0087503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128988A DMEMedicaid
GA990894687AMedicaid
2128897OtherPK
6644040001Medicare NSC