Provider Demographics
NPI:1841247996
Name:MICHAEL'S PHARMACY
Entity type:Organization
Organization Name:MICHAEL'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-274-8876
Mailing Address - Street 1:PO BOX 13269
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-2800
Mailing Address - Country:US
Mailing Address - Phone:478-274-8876
Mailing Address - Fax:478-272-9890
Practice Address - Street 1:203 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-7407
Practice Address - Country:US
Practice Address - Phone:478-274-8876
Practice Address - Fax:478-272-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8707OtherPHARMACY LICENSE
GA457538874AMedicaid
GA457538874BMedicaid
GA457538874BMedicaid
GA457538874AMedicaid