Provider Demographics
NPI:1619945912
Name:A CARTER CLEMENTS JR
Entity Type:Organization
Organization Name:A CARTER CLEMENTS JR
Other - Org Name:RHINE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:229-385-5351
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:RHINE
Mailing Address - State:GA
Mailing Address - Zip Code:31077-0100
Mailing Address - Country:US
Mailing Address - Phone:229-385-5351
Mailing Address - Fax:229-385-6807
Practice Address - Street 1:119 1ST ST
Practice Address - Street 2:
Practice Address - City:RHINE
Practice Address - State:GA
Practice Address - Zip Code:31077-3044
Practice Address - Country:US
Practice Address - Phone:229-385-5351
Practice Address - Fax:229-385-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004653183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00035032AMedicaid
GA1110440001Medicare NSC