Provider Demographics
NPI:1235291642
Name:BRANTLEY DRUG COMPANY, LLC
Entity Type:Organization
Organization Name:BRANTLEY DRUG COMPANY, LLC
Other - Org Name:MARK'S DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:912-462-6386
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553-0865
Mailing Address - Country:US
Mailing Address - Phone:912-462-6386
Mailing Address - Fax:912-462-7657
Practice Address - Street 1:10172 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553
Practice Address - Country:US
Practice Address - Phone:912-462-6386
Practice Address - Fax:912-462-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0059973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00249312AMedicaid
GA4026220001Medicare ID - Type Unspecified