Provider Demographics
NPI:1952446213
Name:ROCHELLE DRUG COMPANY
Entity Type:Organization
Organization Name:ROCHELLE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-365-7447
Mailing Address - Street 1:600 SECOND AVE.
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079
Mailing Address - Country:US
Mailing Address - Phone:229-365-7447
Mailing Address - Fax:229-365-7552
Practice Address - Street 1:600 SECOND AVE.
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079
Practice Address - Country:US
Practice Address - Phone:229-365-7447
Practice Address - Fax:229-365-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0056233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00088756AMedicaid
GA00088756BMedicaid
GA00088756BMedicaid