# MEDICAL CENTER PHARMACY OF STATESBORO, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDICAL CENTER PHARMACY OF STATESBORO, INC
- **Other names:** Medical Center Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1922134089
- **Legal business name:** MEDICAL CENTER PHARMACY OF STATESBORO, INC
- **Authorized official:** MR. JAMES LEMUEL NEVIL III RPH (PHARMACIST/OWNER)
- **Authorized official phone:** (912) 764-5643

## Contact information

- **Practice address:** 57 GRANADE ST, STATESBORO, GA 30458
- **Practice address phone:** (912) 764-5643
- **Practice address fax:** (912) 764-9580
- **Mailing address:** 57 GRANADE ST, STATESBORO, GA 30458
- **Mailing address phone:** (912) 764-5643
- **Mailing address fax:** (912) 764-9580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE006387 | GA | Yes |

## Other

- **Enumeration date:** 02/25/2007
- **Last updated:** 03/07/2023