Provider Demographics
NPI:1659676237
Name:THE MEDICINE CABINET OF DUBLIN LLC
Entity Type:Organization
Organization Name:THE MEDICINE CABINET OF DUBLIN LLC
Other - Org Name:OATTS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-383-0634
Mailing Address - Street 1:1819 RICE AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3603
Mailing Address - Country:US
Mailing Address - Phone:478-272-1822
Mailing Address - Fax:478-274-9562
Practice Address - Street 1:1819 RICE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3603
Practice Address - Country:US
Practice Address - Phone:478-272-1822
Practice Address - Fax:478-274-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
GAPHRE0101583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153302OtherPK
6498080001Medicare NSC
GA00032733A3Medicaid