Tallapoosa RX LLC – Community/Retail Pharmacy

Key facts

NPI: 1013575604
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
Legal business name: TALLAPOOSA RX LLC
Practice address: 2066 US Highway 78
Tallapoosa, GA 30176-1368
Phone: (770) 574-2339
NPI assigned: May 30, 2019
Organization subpart: No

Authorized official

Name: Jacob Mouchet, PHARM D NPI 1700444296
Title: Owner
Phone: (770) 574-2339

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

Corporate family (same tax ID) 1

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

Tallapoosa RX LLC Long Term Care Pharmacy · Tallapoosa, GA · NPI 1629827860

NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jacob Mouchet, PHARM D Pharmacist · Tallapoosa, GA · NPI 1700444296

NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20191031003131	GA	Part B Supplier - Pharmacy	8527390046	Practice locations: Tallapoosa, GA

National Provider Directory

Tax ID family: Tallapoosa Drugs (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Community/Retail Pharmacy	3336C0003X			Yes

Addresses

Primary practice location

2066 US Highway 78
Tallapoosa, GA 30176-1368

Mailing address

PO Box 67
Tallapoosa, GA 30176-0067

Other identifiers

Identifier	Type	State	Issuer
000087997A	Medicaid	GA

Other names

Tallapoosa Drugs Doing business as

Electronic endpoints

Type	Endpoint	Use	Affiliation
Other URL	tallapoosarx@gmail.com	Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 21, 2020.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000087997A",
            "state": "GA"
        }
    ],
    "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

All providers in Tallapoosa, GA · Community/Retail Pharmacy in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.