Provider Demographics
NPI:1710411327
Name:SANDERSVILLE DRUG CO., LLC
Entity Type:Organization
Organization Name:SANDERSVILLE DRUG CO., LLC
Other - Org Name:SANDERSVILLE DRUG CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-232-0998
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-6000
Mailing Address - Country:US
Mailing Address - Phone:478-232-0998
Mailing Address - Fax:
Practice Address - Street 1:528 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1859
Practice Address - Country:US
Practice Address - Phone:478-232-0998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy