Provider Demographics
NPI:1104950815
Name:ADAMS DRUG STORE, INC
Entity type:Organization
Organization Name:ADAMS DRUG STORE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-3433
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-0924
Mailing Address - Country:US
Mailing Address - Phone:229-273-3433
Mailing Address - Fax:229-273-0580
Practice Address - Street 1:408 B 16TH AVE E
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-273-3433
Practice Address - Fax:229-273-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0010603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012171OtherPK
GA00021106A4Medicaid
0607960001Medicare NSC