Provider Demographics
NPI:1386111987
Name:AVERY DRUGS INC.
Entity type:Organization
Organization Name:AVERY DRUGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-291-0999
Mailing Address - Street 1:710 N 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2704
Mailing Address - Country:US
Mailing Address - Phone:706-291-0999
Mailing Address - Fax:706-291-2558
Practice Address - Street 1:710 N 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2704
Practice Address - Country:US
Practice Address - Phone:706-291-0999
Practice Address - Fax:706-291-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000021524AMedicaid