Provider Demographics
NPI:1639644156
Name:MABD ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MABD ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-279-2255
Mailing Address - Street 1:115 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-2957
Mailing Address - Country:US
Mailing Address - Phone:912-616-9922
Mailing Address - Fax:912-616-9923
Practice Address - Street 1:115 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445-2957
Practice Address - Country:US
Practice Address - Phone:912-616-9922
Practice Address - Fax:912-616-9923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MABD ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy