Provider Demographics
NPI:1598707028
Name:ATHENS DISCOUNT DRUGS INC
Entity Type:Organization
Organization Name:ATHENS DISCOUNT DRUGS INC
Other - Org Name:ADD DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC TRS MGR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-548-2239
Mailing Address - Street 1:1695 S LUMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4742
Mailing Address - Country:US
Mailing Address - Phone:706-548-2239
Mailing Address - Fax:706-548-4428
Practice Address - Street 1:1695 S LUMPKIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4742
Practice Address - Country:US
Practice Address - Phone:706-548-2239
Practice Address - Fax:706-548-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0025053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1101740OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA000021128AMedicaid