Provider Demographics
NPI:1700830387
Name:EASTMAN DRUGS, INC.
Entity Type:Organization
Organization Name:EASTMAN DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-374-6670
Mailing Address - Street 1:1221 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-9007
Mailing Address - Country:US
Mailing Address - Phone:478-374-6670
Mailing Address - Fax:478-374-6674
Practice Address - Street 1:1221 PLAZA AVE STE B
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9011
Practice Address - Country:US
Practice Address - Phone:478-374-6670
Practice Address - Fax:478-374-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0032213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00026386AMedicaid
GA0865560001Medicare ID - Type Unspecified