Provider Demographics
NPI:1881314698
Name:HABERSHAM DRUG LTC
Entity type:Organization
Organization Name:HABERSHAM DRUG LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-754-4128
Mailing Address - Street 1:638 HISTORIC HWY 441 SUITE A
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535
Mailing Address - Country:US
Mailing Address - Phone:706-754-4128
Mailing Address - Fax:706-754-4928
Practice Address - Street 1:638 HISTORIC HWY 441N
Practice Address - Street 2:SUITE A
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-3053
Practice Address - Country:US
Practice Address - Phone:706-754-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DFG LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy