Provider Demographics
NPI:1497848105
Name:PHARMA-SERV INC
Entity Type:Organization
Organization Name:PHARMA-SERV INC
Other - Org Name:CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HEBA
Authorized Official - Middle Name:LABIB
Authorized Official - Last Name:KALDAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:706-359-3618
Mailing Address - Street 1:P O BOX 368
Mailing Address - Street 2:114 MAIN STREET
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817
Mailing Address - Country:US
Mailing Address - Phone:706-359-3618
Mailing Address - Fax:706-359-5734
Practice Address - Street 1:114 MAIN STREET
Practice Address - Street 2:CITY PHARMACY
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817
Practice Address - Country:US
Practice Address - Phone:706-359-3618
Practice Address - Fax:706-359-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH.004193333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4946260002Medicare NSC
GA=========Medicare UPIN