NPIMap

Organization Active NPI

Tallapoosa RX LLC

Doing business as Tallapoosa Drugs

  • Community/Retail Pharmacy
  • Tallapoosa, GA
National Provider Identifier
1013575604
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
TALLAPOOSA RX LLC
Doing business as
Tallapoosa Drugs
Practice address
2066 US Highway 78
Tallapoosa, GA 30176-1368
Phone
(770) 574-2339
NPI assigned
May 30, 2019
Last updated
Dec 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Authorized official

Name
Jacob Mouchet, PHARM DNPI 1700444296
Title
Owner
Phone
(770) 574-2339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2066 US Highway 78
Tallapoosa, GA 30176-1368

Mailing address

PO Box 67
Tallapoosa, GA 30176-0067

Other names 1

  • Tallapoosa Drugs Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL tallapoosarx@gmail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191031003131 GA Part B Supplier - Pharmacy 8527390046 Practice locations: Tallapoosa, GA

National Provider Directory

National Provider Directory
Tax ID family
Tallapoosa Drugs2 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.

Locations

2066 US Highway 78
Tallapoosa, GA 30176
Phone (770) 574-2339

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1013575604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "TALLAPOOSA",
            "state": "GA",
            "postal_code": "301760067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2066 US HIGHWAY 78",
            "city": "TALLAPOOSA",
            "state": "GA",
            "postal_code": "301761368",
            "telephone_number": "770-574-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAPOOSA RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "MOUCHET",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-574-2339",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "tallapoosarx@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "24 W Alabama St",
            "city": "Tallapoosa",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301761464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tallapoosa Drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tallapoosa Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallapoosa, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.