Provider Demographics
NPI:1417033671
Name:RLS INC
Entity Type:Organization
Organization Name:RLS INC
Other - Org Name:LANE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-246-1200
Mailing Address - Street 1:823 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-8702
Mailing Address - Country:US
Mailing Address - Phone:229-246-1200
Mailing Address - Fax:229-243-8146
Practice Address - Street 1:823 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-8702
Practice Address - Country:US
Practice Address - Phone:229-246-1200
Practice Address - Fax:229-243-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0055853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000030555BMedicaid
GA000030555AMedicaid
GA1028001OtherUNITED HEALTHCARE PROV ID
GA000030555AMedicaid