Provider Demographics
NPI:1497867337
Name:THE MEDICINE CABINET OF BRUNSWICK, LLC
Entity Type:Organization
Organization Name:THE MEDICINE CABINET OF BRUNSWICK, LLC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-381-8111
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-265-7000
Mailing Address - Fax:912-265-1499
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:STE 102
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-265-7000
Practice Address - Fax:912-265-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0090543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000031776AMedicaid
1106978OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3967310001Medicare NSC