Organization
UNIONVILLE DISCOUNT PHARMACY INC
Active
Other names
Mike's Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE ITEOGU PHARMD (OWNER PHARMACIST)
(478) 742-1448
Entity
Organization
Contact information
Practice address
1381 PIO NONO AVE, MACON, GA 31204-4633
(478) 746-2842
(478) 746-8362
Mailing address
1381 PIO NONO AVE, MACON, GA 31204-4633
(478) 742-1448
(478) 742-1428
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
6785
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00345155A
—
GA
01
—
1131907
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
03/07/2023
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