Provider Demographics
NPI:1700927647
Name:RAINBOW DRUG STORE, INC.
Entity Type:Organization
Organization Name:RAINBOW DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-265-5040
Mailing Address - Street 1:4319 NEW JESUP HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1605
Mailing Address - Country:US
Mailing Address - Phone:912-265-5040
Mailing Address - Fax:912-265-1893
Practice Address - Street 1:4319 NEW JESUP HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1605
Practice Address - Country:US
Practice Address - Phone:912-265-5040
Practice Address - Fax:912-265-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE004743332B00000X, 3336C0004X
GA0047433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000033844AMedicaid
GA5494820002Medicare NSC