Provider Demographics
NPI:1568473395
Name:EULONIA PHARMACY, INC.
Entity Type:Organization
Organization Name:EULONIA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:912-832-6009
Mailing Address - Street 1:15268 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:GA
Mailing Address - Zip Code:31331-3854
Mailing Address - Country:US
Mailing Address - Phone:912-832-6009
Mailing Address - Fax:912-832-6677
Practice Address - Street 1:15268 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-3854
Practice Address - Country:US
Practice Address - Phone:912-832-6009
Practice Address - Fax:912-832-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009069332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00409208AMedicaid
GA00409208AMedicaid