Provider Demographics
NPI:1942800271
Name:MACS LTC PHARMACY GEORGIA LLC
Entity Type:Organization
Organization Name:MACS LTC PHARMACY GEORGIA LLC
Other - Org Name:MACS LTC PHARMACY GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILHOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-806-6453
Mailing Address - Street 1:643 EDGEMOOR RD STE B
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-7146
Mailing Address - Country:US
Mailing Address - Phone:865-945-4441
Mailing Address - Fax:865-945-4158
Practice Address - Street 1:1351 OAKBROOK DR STE 110
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2242
Practice Address - Country:US
Practice Address - Phone:877-638-8716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy