Provider Demographics
NPI:1154415214
Name:PRICE PHARMACY INC
Entity type:Organization
Organization Name:PRICE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-866-8475
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0099
Mailing Address - Country:US
Mailing Address - Phone:706-657-4061
Mailing Address - Fax:706-657-7676
Practice Address - Street 1:4655 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2908
Practice Address - Country:US
Practice Address - Phone:706-657-4061
Practice Address - Fax:706-657-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0052923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00033668AMedicaid
2012864OtherPK
0450470001Medicare NSC