Abundant Life Pharmacy & Health Foods Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009480 Issued in GA

Legal business name

ABUNDANT LIFE PHARMACY & HEALTH FOODS INC

Doing business as

Abundant Life Pharmacy and Health Foods Inc

Practice address

117 N Main St
Baxley, GA 31513-0070

Phone

(912) 367-8404

Fax

(912) 367-8405

NPI assigned

Nov 7, 2007

Last updated

Nov 17, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Hall, PHRMDNPI 1972017242

Title

Owner

Phone

(912) 367-8404

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• ABUNDANT LIFE PHARMACY AND HEALTH FOODS INC Doing business as

Tax ID family

Abundant Life Pharmacy and Health Foods Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Abundant Life Pharmacy & Health Foods Inc

  • Long Term Care Pharmacy
  • Baxley, GA
  • NPI 1760399950
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Lynn Hall

  • Pharmacist
  • Baxley, GA
  • NPI 1972017242
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637107200000",
    "number": "1003096025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 N MAIN ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130070",
            "telephone_number": "912-367-8404",
            "fax_number": "912-367-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N MAIN ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130070",
            "telephone_number": "912-367-8404",
            "fax_number": "912-367-8405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 N Main St",
            "address_purpose": "LOCATION",
            "city": "Baxley",
            "state": "GA",
            "postal_code": "315130070",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ABUNDANT LIFE PHARMACY & HEALTH FOODS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-367-8404",
        "authorized_official_credential": "PHRMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009480",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "359528943A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2017420",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ABUNDANT LIFE PHARMACY AND HEALTH FOODS INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ABUNDANT LIFE PHARMACY AND HEALTH FOODS INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 912 Healthcare, LLC
• Josefina Cathryn Abendan Dubberly, M.D.
• Abundant Life Pharmacy & Health Foods Inc
• Jessica Marie Alferink, FNP
• Juan Alexander Alonso, MS,LAT,ATC
• Altamaha Homecare, Inc.
• Altamaha Homecare, Inc.

• Community/Retail Pharmacy in Baxley, GA
• Providers in Baxley, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.