Provider Demographics
NPI:1710099734
Name:WEBSTERS PHARMACY INC
Entity Type:Organization
Organization Name:WEBSTERS PHARMACY INC
Other - Org Name:WEBSTER'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-444-5296
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-0296
Mailing Address - Country:US
Mailing Address - Phone:706-444-5296
Mailing Address - Fax:706-444-9168
Practice Address - Street 1:12707 BROAD ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1734
Practice Address - Country:US
Practice Address - Phone:706-444-5296
Practice Address - Fax:706-444-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0054813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012788OtherPK
GA00138399AMedicaid
2012788OtherPK