Provider Demographics
NPI:1992220420
Name:WHEELER COUNTY DRUG COMPANY
Entity type:Organization
Organization Name:WHEELER COUNTY DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKELY
Authorized Official - Middle Name:SUTTON
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-279-2582
Mailing Address - Street 1:114 E SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428-3626
Mailing Address - Country:US
Mailing Address - Phone:912-523-2040
Mailing Address - Fax:912-523-2041
Practice Address - Street 1:114 E SECOND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428-3626
Practice Address - Country:US
Practice Address - Phone:912-523-2040
Practice Address - Fax:912-523-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE010371332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies