Organization
MPT PHARMACY LLC
Active
Other names
Jackson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS DANIEL RAINEY PHARM.D. (PHARMACY MANAGER)
(706) 658-0064
Entity
Organization
Contact information
Practice address
170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
(706) 658-0064
(706) 654-0330
Mailing address
170 JOHN RANDOLPH DR, HOSCHTON, GA 30548-1502
(706) 658-0064
(706) 658-0330
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010068
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003149971A
—
GA
01
—
2147287
PK
—
Enumeration date
08/07/2014
Last updated
06/16/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up