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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us