Provider Demographics
NPI:1235172404
Name:UNITED PHARMACY SERVICES
Entity Type:Organization
Organization Name:UNITED PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:678-450-9993
Mailing Address - Street 1:742 MAIN ST SW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4471
Mailing Address - Country:US
Mailing Address - Phone:678-450-9993
Mailing Address - Fax:678-450-9996
Practice Address - Street 1:742 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4471
Practice Address - Country:US
Practice Address - Phone:678-450-9993
Practice Address - Fax:678-450-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006033333600000X
3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1108605OtherNABP
GA00035835BMedicaid
1263510002Medicare ID - Type Unspecified