Provider Demographics
NPI:1528183720
Name:MAYSVILLE PHARMACY, INC.
Entity Type:Organization
Organization Name:MAYSVILLE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-652-2900
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30558-0007
Mailing Address - Country:US
Mailing Address - Phone:706-652-2900
Mailing Address - Fax:706-652-2540
Practice Address - Street 1:8761 MAYSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30558
Practice Address - Country:US
Practice Address - Phone:706-652-2900
Practice Address - Fax:706-652-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy