Provider Demographics
NPI:1154468551
Name:ALLMOND & WHIPPLE, INC.
Entity Type:Organization
Organization Name:ALLMOND & WHIPPLE, INC.
Other - Org Name:CITY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-537-4147
Mailing Address - Street 1:1704 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8913
Mailing Address - Country:US
Mailing Address - Phone:912-537-4147
Mailing Address - Fax:912-537-1914
Practice Address - Street 1:1704 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8913
Practice Address - Country:US
Practice Address - Phone:912-537-4147
Practice Address - Fax:912-537-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003762332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000024879BMedicaid