Provider Demographics
NPI:1629012380
Name:TAYLOR COUNTY DRUG CO INC
Entity Type:Organization
Organization Name:TAYLOR COUNTY DRUG CO INC
Other - Org Name:KNIGHT'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:478-847-3666
Mailing Address - Street 1:2 E WILLIAM WAINWRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDS
Mailing Address - State:GA
Mailing Address - Zip Code:31076-3150
Mailing Address - Country:US
Mailing Address - Phone:478-847-3666
Mailing Address - Fax:478-847-2666
Practice Address - Street 1:2 E WILLIAM WAINWRIGHT ST
Practice Address - Street 2:
Practice Address - City:REYNOLDS
Practice Address - State:GA
Practice Address - Zip Code:31076-3150
Practice Address - Country:US
Practice Address - Phone:478-847-3666
Practice Address - Fax:478-847-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0060493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000160102AMedicaid
1123582OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA000160102AMedicaid