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Organization

ROBERTS PHARMACY INC

Active
Other names
Vital Care of Southwest Georgia, Donalsonville
Organization subpart
No

Provider details

NPI number
Authorized official
JACK H MILLS (PRESIDENT)
(229) 524-2313
Entity
Organization

Contact information

Practice address
803 N WILEY AVE, DONALSONVILLE, GA 39845-1121
(229) 524-2313
(229) 524-1202
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PHRE004506
GA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHRE004506
GA
333600000X
Pharmacy
PHRE004506
GA
3336C0003X
Community/Retail Pharmacy
PHRE004506
GA
3336H0001X
Home Infusion Therapy Pharmacy
PHRE004506
GA
3336L0003X
Long Term Care Pharmacy
PHRE004506
GA
3336M0002X
Mail Order Pharmacy
PHRE004506
GA
3336S0011X
Specialty Pharmacy
PHRE004506
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00035153B
GA
01
277634
BCBS
GA
Enumeration date
07/13/2006
Last updated
12/23/2011
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