Provider Demographics
NPI:1578771580
Name:WRENS DRUG INC
Entity Type:Organization
Organization Name:WRENS DRUG INC
Other - Org Name:WRENS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-547-2225
Mailing Address - Street 1:206 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1109
Mailing Address - Country:US
Mailing Address - Phone:706-547-2225
Mailing Address - Fax:706-547-3012
Practice Address - Street 1:206 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WRENS
Practice Address - State:GA
Practice Address - Zip Code:30833-1109
Practice Address - Country:US
Practice Address - Phone:706-547-2225
Practice Address - Fax:706-547-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0087483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA744933579BMedicaid
2015458OtherPK
GA744933579AMedicaid
GA744933579BMedicaid