Provider Demographics
NPI:1750632188
Name:CHANCY DRUGS LTC LLC
Entity Type:Organization
Organization Name:CHANCY DRUGS LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CHANCY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-794-3525
Mailing Address - Street 1:205B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1121
Mailing Address - Country:US
Mailing Address - Phone:229-794-1974
Mailing Address - Fax:229-794-1059
Practice Address - Street 1:205B E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1121
Practice Address - Country:US
Practice Address - Phone:229-794-1974
Practice Address - Fax:229-794-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RPH015705333600000X
GARPH0157053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy