Organization
EDISON PHARMACY LLC
Active
Other names
LANE DRUG CO
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD F REYNOLDS RPH (OWNER MGR)
(229) 835-2212
Entity
Organization
Contact information
Practice address
19427 HARTFORD ST, EDISON, GA 39846-5627
(229) 835-2212
(229) 835-2572
Mailing address
PO BOX 248, EDISON, GA 39846-0248
(229) 835-2211
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE000311
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000030533A
—
GA
01
—
2012347
PK
—
Enumeration date
01/08/2007
Last updated
10/27/2015
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