Organization
MAK PHARMACY LLC
Active
Other names
MAK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MILLSAPS (PHARMACIST/CEO)
(229) 336-7654
Entity
Organization
Contact information
Practice address
159 E BROAD ST, CAMILLA, GA 31730-1842
(229) 336-7654
(229) 336-5615
Mailing address
PO BOX 394, CAMILLA, GA 31730-0394
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009536
GA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027448369A
—
GA
01
—
1158167
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/19/2008
Last updated
03/09/2009
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