Organization
HINES PRESCRIPTION SHOP, INC.
Active
Other names
HINES PRESCRIPTION SHOP
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TYLER YOUNG (PRESIDENT)
(770) 358-2266
Entity
Organization
Contact information
Practice address
302 COLLEGE DR, BARNESVILLE, GA 30204-1602
(770) 358-2266
(770) 358-4497
Mailing address
302 COLLEGE DR, BARNESVILLE, GA 30204-1602
(770) 358-2266
(770) 358-4497
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006093
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00029323A
—
GA
01
—
2013044
PK
—
Enumeration date
05/25/2006
Last updated
03/19/2021
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