Provider Demographics
NPI:1356595417
Name:EXPRESS RX PHARMACY, LLC.
Entity type:Organization
Organization Name:EXPRESS RX PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:478-742-3020
Mailing Address - Street 1:743 SHURLING DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1947
Mailing Address - Country:US
Mailing Address - Phone:478-742-3020
Mailing Address - Fax:478-742-3020
Practice Address - Street 1:743 SHURLING DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1947
Practice Address - Country:US
Practice Address - Phone:478-742-3020
Practice Address - Fax:478-742-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-15
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6261150002Medicare NSC