Organization
1ST AMERICA DRUGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SUTTLES HICKS R.PH. (PHARMACY MANAGER)
(229) 242-3060
Entity
Organization
Contact information
Practice address
212 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 242-3060
(229) 316-1366
Mailing address
212 NORTHSIDE DR, VALDOSTA, GA 31602-1858
(229) 242-3060
(229) 316-1366
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006491
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003314689
ENVOY ID.
GA
05
—
00339248A
—
GA
Enumeration date
08/20/2006
Last updated
08/22/2020
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