Provider Demographics
NPI:1861557639
Name:SAWNEE DRUG CO
Entity type:Organization
Organization Name:SAWNEE DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-889-8900
Mailing Address - Street 1:2515 BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-4394
Mailing Address - Country:US
Mailing Address - Phone:770-889-8900
Mailing Address - Fax:770-887-8306
Practice Address - Street 1:2515 BUSINESS DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-4394
Practice Address - Country:US
Practice Address - Phone:770-889-8900
Practice Address - Fax:770-887-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0069993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00380135BMedicaid
GA00380135BMedicaid