# PRESBYTERIAN HOME PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PRESBYTERIAN HOME PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760528285
- **Authorized official:** ALEX PATTERSON MS (EXCTV DIR)
- **Authorized official phone:** (229) 263-6101

## Contact information

- **Practice address:** 1901 W SCREVEN ST, QUITMAN, GA 31643-3913
- **Practice address phone:** (229) 263-6130
- **Practice address fax:** (229) 263-6169
- **Mailing address:** PO BOX 407, QUITMAN, GA 31643-0407

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHRE005010 | GA | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 12/08/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00142579B | — | GA |
| 01 | — | 2017528 | PK | — |