Provider Demographics
NPI:1669522645
Name:MEDICAL CENTER PHARMACY INC
Entity type:Organization
Organization Name:MEDICAL CENTER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-237-3838
Mailing Address - Street 1:132 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3235
Mailing Address - Country:US
Mailing Address - Phone:478-237-3838
Mailing Address - Fax:478-237-3878
Practice Address - Street 1:132 VICTORY DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3235
Practice Address - Country:US
Practice Address - Phone:478-237-3838
Practice Address - Fax:478-237-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0086343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00954478AMedicaid
1150046OtherNCPDP
1150046OtherNCPDP