# MPT PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073922670
- **Authorized official:** ROSS DANIEL RAINEY PHARM.D. (PHARMACY MANAGER)
- **Authorized official phone:** (706) 658-0064

## Contact information

- **Practice address:** 170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
- **Practice address phone:** (706) 658-0064
- **Practice address fax:** (706) 654-0330
- **Mailing address:** 170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
- **Mailing address phone:** (706) 658-0064
- **Mailing address fax:** (706) 658-0330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE010068 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/07/2014
- **Last updated:** 06/16/2025