Provider Demographics
NPI:1326114109
Name:APOTHECARY ASSOCIATES INC
Entity Type:Organization
Organization Name:APOTHECARY ASSOCIATES INC
Other - Org Name:GIBSON'S DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-273-6660
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-1272
Mailing Address - Country:US
Mailing Address - Phone:229-273-6660
Mailing Address - Fax:229-271-3890
Practice Address - Street 1:716 E 16TH AVE
Practice Address - Street 2:SUITE I
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4516
Practice Address - Country:US
Practice Address - Phone:229-273-6660
Practice Address - Fax:229-271-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000028311AMedicaid
GA000028311AMedicaid