Provider Demographics
NPI:1285849836
Name:COMMUNITY DISCOUNT PARMACY
Entity type:Organization
Organization Name:COMMUNITY DISCOUNT PARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4671
Mailing Address - Street 1:310 W GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-3258
Mailing Address - Country:US
Mailing Address - Phone:229-432-7839
Mailing Address - Fax:229-434-9873
Practice Address - Street 1:310 W GORDON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-3258
Practice Address - Country:US
Practice Address - Phone:229-432-7839
Practice Address - Fax:229-434-9873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY DISCOUNT PARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0066933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00332604AMedicaid