Provider Demographics
NPI:1780633925
Name:LANIER & REGISTER PHARMACY, INC.
Entity Type:Organization
Organization Name:LANIER & REGISTER PHARMACY, INC.
Other - Org Name:WAINRIGHT'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KNOX
Authorized Official - Last Name:WAINRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-283-1532
Mailing Address - Street 1:1401 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4528
Mailing Address - Country:US
Mailing Address - Phone:912-283-1532
Mailing Address - Fax:912-285-1388
Practice Address - Street 1:1401 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4528
Practice Address - Country:US
Practice Address - Phone:912-283-1532
Practice Address - Fax:912-285-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005580261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00030566AMedicaid
GAPHRE005580OtherPHARMACY LICENSE NO.
GA00030566AMedicaid
GA00030566AMedicaid