# AUTRY STATE PRISON PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GEORGIA DEPARTMENT OF CORRECTIONS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1831689728
- **Legal business name:** GEORGIA DEPARTMENT OF CORRECTIONS
- **Authorized official:** DEENA JONES GAINOUS PHARMD (PHARMACY DIRECTOR)
- **Authorized official phone:** (229) 294-6786

## Contact information

- **Practice address:** 3178 MOUNT ZION CHURCH RD, PELHAM, GA 31779
- **Practice address phone:** (229) 294-6786
- **Practice address fax:** (229) 294-6788
- **Mailing address:** PO BOX 648, PELHAM, GA 31779-0648
- **Mailing address phone:** (229) 294-6786
- **Mailing address fax:** (229) 294-6788

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | PHPR007470 | GA | Yes |

## Other

- **Enumeration date:** 05/16/2018
- **Last updated:** 05/23/2018