Provider Demographics
NPI:1558409078
Name:INFU-RX, INC. DBA FAMILY DRUG CENTER
Entity Type:Organization
Organization Name:INFU-RX, INC. DBA FAMILY DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:706-632-3688
Mailing Address - Street 1:114 PROFESSIONAL RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:706-632-3688
Mailing Address - Fax:706-632-2398
Practice Address - Street 1:114 PROFESSIONAL RD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6205
Practice Address - Country:US
Practice Address - Phone:706-632-3688
Practice Address - Fax:706-632-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0049893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1135563OtherNABP NUMBER
GA00405985AMedicaid