Provider Demographics
NPI:1245799857
Name:DOGWOOD PHARMACY LTC
Entity Type:Organization
Organization Name:DOGWOOD PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:EUGENA
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-316-8200
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 11
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8213
Mailing Address - Country:US
Mailing Address - Phone:229-256-2411
Mailing Address - Fax:229-256-2488
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 11
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8213
Practice Address - Country:US
Practice Address - Phone:229-256-2411
Practice Address - Fax:229-256-2488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOGWOOD PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-14
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy