Provider Demographics
NPI:1740380484
Name:TOWNE PHARMACY OF RINCON LLC
Entity Type:Organization
Organization Name:TOWNE PHARMACY OF RINCON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:MC MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-826-0250
Mailing Address - Street 1:6014 HIGHWAY 21 S STE P
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5573
Mailing Address - Country:US
Mailing Address - Phone:912-826-0250
Mailing Address - Fax:912-826-0717
Practice Address - Street 1:6014 HIGHWAY 21 SOUTH
Practice Address - Street 2:STE O AND P
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-826-0250
Practice Address - Fax:912-826-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008972183500000X, 3336C0003X
GA018937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA147147747AMedicaid
GA5545580001Medicare NSC
5545580001Medicare NSC