Provider Demographics
NPI:1437214012
Name:PHILLIPS DRUGS, INC
Entity Type:Organization
Organization Name:PHILLIPS DRUGS, INC
Other - Org Name:PHILLIPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:GOURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-537-3049
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0120
Mailing Address - Country:US
Mailing Address - Phone:912-537-3049
Mailing Address - Fax:912-537-3040
Practice Address - Street 1:306 W 1ST ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3369
Practice Address - Country:US
Practice Address - Phone:912-537-3049
Practice Address - Fax:912-537-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003663333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00033228AMedicaid
GA1115369OtherNCPDP
GA1115369OtherNCPDP