Provider Demographics
NPI:1013933258
Name:TAYLORSVILLE DRUG CO INC.
Entity Type:Organization
Organization Name:TAYLORSVILLE DRUG CO INC.
Other - Org Name:TAYLORSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:MRS
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 1:105 CHURCH ST
Mailing Address - Street 2:P.O. BOX 146
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30178-1904
Mailing Address - Country:US
Mailing Address - Phone:770-684-9060
Mailing Address - Fax:770-684-8686
Practice Address - Street 1:105 CHURCH ST
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30178-1904
Practice Address - Country:US
Practice Address - Phone:770-684-9060
Practice Address - Fax:770-684-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016743183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00272016AMedicaid
GA3988120001Medicare ID - Type Unspecified