Provider Demographics
NPI:1316081045
Name:COX PHARMACY INC.
Entity type:Organization
Organization Name:COX PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-377-9017
Mailing Address - Street 1:300 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2726
Mailing Address - Country:US
Mailing Address - Phone:229-377-9017
Mailing Address - Fax:229-377-3994
Practice Address - Street 1:300 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2726
Practice Address - Country:US
Practice Address - Phone:229-377-9017
Practice Address - Fax:229-377-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
GAPHRE006069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1127326OtherNATIONAL PROVIDER ID
GA00255956AMedicaid
GA0515220001Medicare ID - Type Unspecified