Provider Demographics
NPI:1639115025
Name:CLINIC PHARMACY INC
Entity Type:Organization
Organization Name:CLINIC PHARMACY INC
Other - Org Name:CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BEECHER
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-2151
Mailing Address - Street 1:58 BIG A RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577
Mailing Address - Country:US
Mailing Address - Phone:706-886-2151
Mailing Address - Fax:706-297-7519
Practice Address - Street 1:58 BIG A RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6017
Practice Address - Country:US
Practice Address - Phone:706-886-2151
Practice Address - Fax:706-297-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
GAPHRE0029113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019114OtherPK
GA00647017AMedicaid
2019114OtherPK
1141441OtherOTHER ID NUMBER