Provider Demographics
NPI:1225022916
Name:RICHMOND HILL PHARMACY INC
Entity Type:Organization
Organization Name:RICHMOND HILL PHARMACY INC
Other - Org Name:RICHMOND HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-756-3331
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-1060
Mailing Address - Country:US
Mailing Address - Phone:912-756-3331
Mailing Address - Fax:912-756-5904
Practice Address - Street 1:2409 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3756
Practice Address - Country:US
Practice Address - Phone:912-756-3331
Practice Address - Fax:912-756-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GAPHRE0062853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00284094AMedicaid
2014036OtherPK
0168700001Medicare NSC