Provider Demographics
NPI:1770889040
Name:CHIPS DISCOUNT DRUGS INC
Entity type:Organization
Organization Name:CHIPS DISCOUNT DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGERS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-375-3218
Mailing Address - Street 1:P.O. BOX 571
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-0571
Mailing Address - Country:US
Mailing Address - Phone:912-375-3218
Mailing Address - Fax:912-375-3214
Practice Address - Street 1:240 S. TALLAHASSEE ST.
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-0571
Practice Address - Country:US
Practice Address - Phone:912-375-3218
Practice Address - Fax:912-375-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0097233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108353AMedicaid