Provider Demographics
NPI:1578611760
Name:EXPRESSMED, INC.
Entity Type:Organization
Organization Name:EXPRESSMED, INC.
Other - Org Name:EXPRESSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-754-0101
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0004
Mailing Address - Country:US
Mailing Address - Phone:706-754-0101
Mailing Address - Fax:706-754-9753
Practice Address - Street 1:410A W LOUISE ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5808
Practice Address - Country:US
Practice Address - Phone:706-754-0101
Practice Address - Fax:706-754-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy