Provider Demographics
NPI:1386710481
Name:ALAN R MCELVEEEN
Entity type:Organization
Organization Name:ALAN R MCELVEEEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-7675
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0391
Mailing Address - Country:US
Mailing Address - Phone:770-534-7675
Mailing Address - Fax:770-718-9451
Practice Address - Street 1:1210 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1779
Practice Address - Country:US
Practice Address - Phone:770-534-7675
Practice Address - Fax:770-718-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
GAPHRE0066683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00031468AMedicaid
1110244OtherNCPDP PROVIDER IDENTIFICATION NUMBER