Provider Demographics
NPI:1437221165
Name:THE PRESCRIPTION SHOPPE
Entity Type:Organization
Organization Name:THE PRESCRIPTION SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEDINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-7400
Mailing Address - Street 1:302 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2800
Mailing Address - Country:US
Mailing Address - Phone:478-275-7400
Mailing Address - Fax:478-274-0053
Practice Address - Street 1:302 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2800
Practice Address - Country:US
Practice Address - Phone:478-275-7400
Practice Address - Fax:478-274-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7050333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00393654AMedicaid
GA00393654AMedicaid
GA4918480001Medicare NSC