Provider Demographics
NPI:1164114666
Name:CHANCY DRUGS NORTH VALDOSTA LLC
Entity Type:Organization
Organization Name:CHANCY DRUGS NORTH VALDOSTA LLC
Other - Org Name:AMERIMED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-794-3525
Mailing Address - Street 1:205B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1121
Mailing Address - Country:US
Mailing Address - Phone:229-794-3525
Mailing Address - Fax:229-794-1059
Practice Address - Street 1:3782 OLD US 41 N
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6882
Practice Address - Country:US
Practice Address - Phone:229-253-0067
Practice Address - Fax:229-219-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy