HOSPITAL PHARMACY OF MOULTRIE INC (CONVENIENT CARE PHARMACY #1) - NPI NUMBER 1558427468

Summary

Provider Name: HOSPITAL PHARMACY OF MOULTRIE INC (CONVENIENT CARE PHARMACY #1)

NPI Number: 1558427468

Clasification: Pharmacy (3336C0003X)

Specialization: Community/Retail Pharmacy

Address:
203 31ST AVE SE
MOULTRIE, GA
ZIP 31768

Phone Number: (229) 985-9296



Detailed Information

HOSPITAL PHARMACY OF MOULTRIE INC is a community/retail pharmacy pharmacy in Moultrie, GA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. The assigned NPI number for this provider is 1558427468 and is registered as an organization entity type.
The provider Is Doing Business As Convenient Care Pharmacy #1.

The provider's business address is:

203 31ST AVE SE
MOULTRIE, GA
ZIP 31768-703
Phone: (229) 985-9296
Fax: (229) 985-3771

The provider's authorized official is Gregory L Yarbrough .
The authorized official title is President and has the following contact phone number (229) 985-9296.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 9/24/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336C0003X Pharmacy Community/Retail Pharmacy 4738 GA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 1225350001 MEDICARE NSC
2 1116981 OTHER NCPDP #
3 00069858A MEDICAID GA

NPI Record

No. Field Name Field Value
1 NPI 1558427468
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name HOSPITAL PHARMACY OF MOULTRIE INC
5 Provider Other Organization Name CONVENIENT CARE PHARMACY #1
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 203 31ST AVE SE
8 Provider Business Practice Location Address City Name MOULTRIE
9 Provider Business Practice Location Address State Name GA
10 Provider Business Practice Location Address Postal Code 317686703
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 2299859296
13 Provider Business Practice Location Address Fax Number 2299853771
14 Provider Enumeration Date 12/28/2006
15 Last Update Date 9/24/2013
16 Authorized Official Last Name YARBROUGH
17 Authorized Official First Name GREGORY
18 Authorized Official Middle Name L
19 Authorized Official Title or Position PRESIDENT
20 Authorized Official Telephone Number 2299859296
21 Healthcare Provider Taxonomy Code 1 3336C0003X
22 Provider License Number 1 4738
23 Provider License Number State Code 1 GA
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 1225350001
26 Other Provider Identifier Type Code 1 07
27 Other Provider Identifier 2 1116981
28 Other Provider Identifier Type Code 2 01
29 Other Provider Identifier Issuer 2 NCPDP #
30 Other Provider Identifier 3 00069858A
31 Other Provider Identifier Type Code 3 05
32 Other Provider Identifier State 3 GA
33 Is Organization Subpart N
34 Authorized Official Credential Text R.PH.

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.