Provider Demographics
NPI:1942226196
Name:TEMPLE PHARMACY, INC.
Entity Type:Organization
Organization Name:TEMPLE PHARMACY, INC.
Other - Org Name:TEMPLE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-684-9060
Mailing Address - Street 1:285 SAGE ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-3846
Mailing Address - Country:US
Mailing Address - Phone:770-562-3268
Mailing Address - Fax:770-562-1414
Practice Address - Street 1:285 SAGE ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30179-3846
Practice Address - Country:US
Practice Address - Phone:770-562-3268
Practice Address - Fax:770-562-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
GAPHRE005918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00037001AMedicaid
GA00037001BMedicaid
GA0589450001Medicare NSC