Provider Demographics
NPI:1437730934
Name:VILLAGE DRUG SHOP OF ATHENS INC
Entity Type:Organization
Organization Name:VILLAGE DRUG SHOP OF ATHENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:THURMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-548-4444
Mailing Address - Street 1:740 PRINCE AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5900
Mailing Address - Country:US
Mailing Address - Phone:706-548-4444
Mailing Address - Fax:706-548-2193
Practice Address - Street 1:740 PRINCE AVE STE 16
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5900
Practice Address - Country:US
Practice Address - Phone:706-548-4444
Practice Address - Fax:706-548-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE003245OtherPHARMACY LICENSE
GA000303509AMedicaid
AV3156937OtherDEA