Provider Demographics
NPI:1801390919
Name:HORTONS DRUG STORE INC
Entity Type:Organization
Organization Name:HORTONS DRUG STORE INC
Other - Org Name:HORTONS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:JONAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-543-5434
Mailing Address - Street 1:8612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4829
Mailing Address - Country:US
Mailing Address - Phone:678-285-0760
Mailing Address - Fax:770-971-0315
Practice Address - Street 1:101 E CLAYTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2702
Practice Address - Country:US
Practice Address - Phone:706-543-3454
Practice Address - Fax:706-543-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0034903336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176382OtherPK