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Organization
MIMBS DRUG CO
Active
Organization
MIMBS DRUG CO
Active
Other names
DIXIE CITY PHARMACY 1
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE H MIMBS RPH (PRESIDENT)
(770) 536-3329
Entity
Organization
Contact information
Practice address
1077 JESSE JEWELL PKWY SW, GAINESVILLE, GA 30501-6103
(770) 536-3329
(770) 536-0462
Mailing address
1077 JESSE JEWELL PKWY SW, GAINESVILLE, GA 30501-6103
(770) 536-3329
(770) 536-0462
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHRE003427
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00025891A
—
GA
05
—
00025891B
—
GA
01
—
1102689
NCPDP
GA
01
—
PHRE003427
STATE LISC NO
GA
Enumeration date
11/05/2005
Last updated
03/07/2023
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