Provider Demographics
NPI:1649572702
Name:WYNNS PHARMACY SERVICES
Entity Type:Organization
Organization Name:WYNNS PHARMACY SERVICES
Other - Org Name:WYNNS PHARNACY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:OSGOOD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:P PH
Authorized Official - Phone:770-467-6500
Mailing Address - Street 1:107 GRAEFE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4221
Mailing Address - Country:US
Mailing Address - Phone:770-467-6500
Mailing Address - Fax:770-467-6513
Practice Address - Street 1:107 GRAEFE ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4221
Practice Address - Country:US
Practice Address - Phone:770-467-6500
Practice Address - Fax:770-467-6513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYNNS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-23
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006081332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0183810001Medicare NSC