Provider Demographics
NPI:1275692683
Name:ANGLIN'S DRUG STORE, INC
Entity Type:Organization
Organization Name:ANGLIN'S DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-945-9501
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0547
Mailing Address - Country:US
Mailing Address - Phone:770-945-9501
Mailing Address - Fax:770-932-6169
Practice Address - Street 1:85 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5712
Practice Address - Country:US
Practice Address - Phone:770-945-9501
Practice Address - Fax:770-932-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0022353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1103453OtherNCPDP
GA00021326AMedicaid
GA0988140001Medicare ID - Type Unspecified