Provider Demographics
NPI:1245378827
Name:S & P DRUG CO
Entity Type:Organization
Organization Name:S & P DRUG CO
Other - Org Name:OCMULGEE DRUG CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:229-868-6756
Mailing Address - Street 1:209 W OAK ST
Mailing Address - Street 2:P O BOX 297
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-1520
Mailing Address - Country:US
Mailing Address - Phone:229-868-6756
Mailing Address - Fax:229-868-2032
Practice Address - Street 1:209 W OAK ST
Practice Address - Street 2:209 W OAK ST
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-1520
Practice Address - Country:US
Practice Address - Phone:229-868-6756
Practice Address - Fax:229-868-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABR203 2007332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00354274BMedicaid