Provider Demographics
NPI:1215047501
Name:MIDTOWN PHARMACY INC
Entity type:Organization
Organization Name:MIDTOWN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-596-8871
Mailing Address - Street 1:2660 BUENA VISTA RD STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3914
Mailing Address - Country:US
Mailing Address - Phone:706-596-8871
Mailing Address - Fax:706-596-8182
Practice Address - Street 1:2660 BUENA VISTA RD STE A
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3914
Practice Address - Country:US
Practice Address - Phone:706-596-8871
Practice Address - Fax:706-596-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0074413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0710380001Medicare ID - Type Unspecified