Provider Demographics
NPI:1811986086
Name:WIREGRASS DRUGS, INC.
Entity type:Organization
Organization Name:WIREGRASS DRUGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:PO BOX 72188
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2188
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-435-4734
Practice Address - Street 1:702 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-1632
Practice Address - Country:US
Practice Address - Phone:334-684-0453
Practice Address - Fax:334-684-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102190332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051047Medicaid
AL51051047OtherBC/BS
FL100432801Medicaid
AL000051047Medicaid