Provider Demographics
NPI:1619002623
Name:CATHEY VALLEY PHARMACY INC
Entity Type:Organization
Organization Name:CATHEY VALLEY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:6712 US HWY 441
Mailing Address - Street 2:
Mailing Address - City:DILLARD
Mailing Address - State:GA
Mailing Address - Zip Code:30537
Mailing Address - Country:US
Mailing Address - Phone:706-746-5335
Mailing Address - Fax:800-347-9865
Practice Address - Street 1:6712 US HWY 441
Practice Address - Street 2:
Practice Address - City:DILLARD
Practice Address - State:GA
Practice Address - Zip Code:30537
Practice Address - Country:US
Practice Address - Phone:706-746-5335
Practice Address - Fax:800-347-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003315332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52614889001OtherBCBS
NC7702080Medicaid
GA0000377716BMedicaid
SCDME1064Medicaid
GA1121820001Medicare NSC