Provider Demographics
NPI:1508870155
Name:UNIVERSAL PHARM INC
Entity Type:Organization
Organization Name:UNIVERSAL PHARM INC
Other - Org Name:DOCTORS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM
Authorized Official - Phone:478-472-2040
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-0322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068
Practice Address - Country:US
Practice Address - Phone:478-472-2040
Practice Address - Fax:912-472-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0069103336C0003X, 332BX2000X, 332BP3500X, 333600000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0036295317Medicaid
2015889OtherPK