Organization
CLINIC DRUG STORE, INC.
Active
Other names
CLINIC DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
LEE PINNELL (OWNER)
(229) 942-5170
Entity
Organization
Contact information
Practice address
1001 E FORSYTH ST, AMERICUS, GA 31709-3721
(229) 924-2783
(229) 924-9220
Mailing address
PO BOX 445, AMERICUS, GA 31709-0445
(229) 924-2783
(229) 924-9220
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE003303
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000025088A
—
GA
01
—
2162319
PK
—
Enumeration date
08/02/2016
Last updated
08/02/2016
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