Provider Demographics
NPI:1346513835
Name:CALHOUN DRUG COMPANY LLC
Entity Type:Organization
Organization Name:CALHOUN DRUG COMPANY LLC
Other - Org Name:CALHOUN DRUG CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:P.I.C.
Authorized Official - Prefix:
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTUW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-629-2426
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-0625
Mailing Address - Country:US
Mailing Address - Phone:706-629-2426
Mailing Address - Fax:
Practice Address - Street 1:450 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1959
Practice Address - Country:US
Practice Address - Phone:706-629-2426
Practice Address - Fax:706-629-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GAPHRE0098023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133879OtherPK
1162128OtherNCPDP PROVIDER IDENTIFICATION NUMBER