Provider Demographics
NPI:1972094134
Name:VALDOSTA STATE PRISON REGIONAL PHARMACY
Entity Type:Organization
Organization Name:VALDOSTA STATE PRISON REGIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-333-7943
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0310
Mailing Address - Country:US
Mailing Address - Phone:229-333-7943
Mailing Address - Fax:229-333-7966
Practice Address - Street 1:3259 VAL TECH RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-9309
Practice Address - Country:US
Practice Address - Phone:229-333-7943
Practice Address - Fax:229-333-7966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA DEPARTMENT OF CORRECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHPR0035193336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy