Provider Demographics
NPI:1851073274
Name:MADISON DRUG, LLC
Entity Type:Organization
Organization Name:MADISON DRUG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-342-1722
Mailing Address - Street 1:213 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1312
Mailing Address - Country:US
Mailing Address - Phone:706-342-1722
Mailing Address - Fax:706-342-3227
Practice Address - Street 1:213 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-1312
Practice Address - Country:US
Practice Address - Phone:706-342-1722
Practice Address - Fax:706-342-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy