Provider Demographics
NPI:1740384791
Name:ROY POWELLS DRUG STORE INC
Entity Type:Organization
Organization Name:ROY POWELLS DRUG STORE INC
Other - Org Name:ROY POWELLS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-384-1792
Mailing Address - Street 1:223 ASHLEY ST W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2349
Mailing Address - Country:US
Mailing Address - Phone:912-384-1793
Mailing Address - Fax:912-384-3627
Practice Address - Street 1:223 ASHLEY ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2349
Practice Address - Country:US
Practice Address - Phone:912-384-1793
Practice Address - Fax:912-384-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0034243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1109304OtherNCPDP PROVIDER IDENTIFICATION NUMBER