Provider Demographics
NPI:1124584214
Name:PHARMA ST RX LLC
Entity Type:Organization
Organization Name:PHARMA ST RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-715-1527
Mailing Address - Street 1:519 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4101
Mailing Address - Country:US
Mailing Address - Phone:229-495-3133
Mailing Address - Fax:239-329-4432
Practice Address - Street 1:519 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4101
Practice Address - Country:US
Practice Address - Phone:239-495-3133
Practice Address - Fax:229-329-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy