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CLINIC DRUG STORE NPI 1073582920


NPI Information

NPI: 1073582920
Provider Name: CLINIC DRUG STORE
Classification: Pharmacy - 333600000X
Entity Type: Organization

CLIA Number: 11D1042596

Address:
1001 E FORSYTH ST
AMERICUS, GA
ZIP 31709
Phone: (229) 924-2783
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CLINIC DRUG STORE is a pharmacy in Americus, GA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. CLINIC DRUG STORE NPI is 1073582920. The provider is registered as an organization entity type.

The provider's business location address is:

1001 E FORSYTH ST
AMERICUS, GA
ZIP 31709-721
Phone: (229) 924-2783
Fax: (229) 924-9220

The provider's authorized official is Lee Fouche' Pinnell .
The authorized official title is Co-owner and has the following contact phone number (229) 924-2783.

The CLIA number assigned to this NPI record is 11D1042596 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 2/14/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1333600000XPharmacy003303GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11104481OTHERNABP/NCPDP
200025088AMEDICAIDGEORGIA
30602290001MEDICARE NSCGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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.