Provider Demographics
NPI:1679056584
Name:HEPHZIBAH DRUG LLC
Entity Type:Organization
Organization Name:HEPHZIBAH DRUG LLC
Other - Org Name:HEPHZIBAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:FLAKES
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:706-592-4646
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-0265
Mailing Address - Country:US
Mailing Address - Phone:706-592-4646
Mailing Address - Fax:706-592-4618
Practice Address - Street 1:4819 WINDSOR SPRING RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4848
Practice Address - Country:US
Practice Address - Phone:706-592-4646
Practice Address - Fax:706-592-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0106513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy