Provider Demographics
NPI:1194015073
Name:MOBLEY'S DISCOUNT PHARMACY, INC. #2
Entity Type:Organization
Organization Name:MOBLEY'S DISCOUNT PHARMACY, INC. #2
Other - Org Name:MOBLEY'S DISCOUNT PHARMACY, INC. #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-383-7947
Mailing Address - Street 1:215 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2911
Mailing Address - Country:US
Mailing Address - Phone:912-632-6322
Mailing Address - Fax:912-632-2246
Practice Address - Street 1:215 E 16TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2911
Practice Address - Country:US
Practice Address - Phone:912-632-6322
Practice Address - Fax:912-632-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GAPHRE0096573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1161328OtherNCPDP PROVIDER IDENTIFICATION NUMBER