Provider Demographics
NPI:1831260488
Name:MONROE DRUG COMPANY
Entity type:Organization
Organization Name:MONROE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:HAMBY
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:770-267-2530
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1006
Mailing Address - Country:US
Mailing Address - Phone:770-267-2530
Mailing Address - Fax:
Practice Address - Street 1:221 S MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1629
Practice Address - Country:US
Practice Address - Phone:770-267-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0027613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00032238AMedicaid
GA00032238AMedicaid