Provider Demographics
NPI:1982633277
Name:C & C PHARMACY INC.
Entity Type:Organization
Organization Name:C & C PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CURL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-445-2600
Mailing Address - Street 1:621 W MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4120
Mailing Address - Country:US
Mailing Address - Phone:770-445-2600
Mailing Address - Fax:770-445-1626
Practice Address - Street 1:621 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4120
Practice Address - Country:US
Practice Address - Phone:770-445-2600
Practice Address - Fax:770-445-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0051783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00031534AMedicaid
GA00031534AMedicaid