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Organization
MIDCITY PHARMACY
Active
Organization
MIDCITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM GRADY CAGLE JR. PHARMIST (OWNER)
(770) 479-5533
Entity
Organization
Contact information
Practice address
196 E MAIN ST, CANTON, GA 30114-2707
(770) 479-5533
(770) 479-5534
Mailing address
196 E MAIN ST, CANTON, GA 30114-2707
(770) 479-5533
(770) 479-5534
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8181
GA
332B00000X
Durable Medical Equipment & Medical Supplies
332B00000X
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00032051A
—
GA
05
—
00032051B
—
GA
01
—
1102401
NABP
GA
01
—
87BBBCS
MEDICARE PART B
—
Enumeration date
11/29/2006
Last updated
07/19/2008
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