Organization
PIONEER HEALTH SERVICES OF EARLY COUNTY LLC
Active
Other names
Pioneer Community Hospital of Early
Organization subpart
No
Provider details
NPI number
Authorized official
WADE COOK (DIR OF PHCY)
(229) 724-4208
Entity
Organization
Contact information
Practice address
11740 COLUMBIA ST, BLAKELY, GA 39823-2574
(229) 724-4208
(229) 724-4268
Mailing address
11740 COLUMBIA ST, BLAKELY, GA 39823-2574
(229) 724-4208
(229) 724-4268
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE09691
GA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000635A
—
GA
01
—
2127003
PK
—
Enumeration date
09/27/2006
Last updated
07/02/2015
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