Provider Demographics
NPI:1588778559
Name:GMC PHARMACY LLC
Entity type:Organization
Organization Name:GMC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OZMENT
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:706-234-7616
Mailing Address - Street 1:PO BOX 2936
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30164-2936
Mailing Address - Country:US
Mailing Address - Phone:706-234-7616
Mailing Address - Fax:706-234-7156
Practice Address - Street 1:3402 ALABAMA HWY NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-9652
Practice Address - Country:US
Practice Address - Phone:706-234-7616
Practice Address - Fax:706-234-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0094733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016363OtherPK
GA00028168AMedicaid
6083540001Medicare NSC