Provider Demographics
NPI:1063432979
Name:LEXINTON PHARMACIES INC.
Entity type:Organization
Organization Name:LEXINTON PHARMACIES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HANSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-743-5477
Mailing Address - Street 1:778 ATHENS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30648
Mailing Address - Country:US
Mailing Address - Phone:706-743-5477
Mailing Address - Fax:706-743-3655
Practice Address - Street 1:778 ATHENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648
Practice Address - Country:US
Practice Address - Phone:706-743-5477
Practice Address - Fax:706-743-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12478183500000X
GA056173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05617Medicaid
GA00201968Medicaid