Provider Demographics
NPI:1386917771
Name:H G PHARMA, INC
Entity type:Organization
Organization Name:H G PHARMA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST I/C- C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOTI
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:678-860-3854
Mailing Address - Street 1:8480 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2411
Mailing Address - Country:US
Mailing Address - Phone:770-726-7357
Mailing Address - Fax:888-423-5016
Practice Address - Street 1:8480 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2411
Practice Address - Country:US
Practice Address - Phone:770-726-7357
Practice Address - Fax:888-423-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PHRE009816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE009816Medicaid