Avera Drug Co
Organization Active NPI Pharmacist · Fort Valley, GA
NPI 1013986744 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1013986744
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist 183500000X
- License
- 10944 (GA)
- Legal business name
- AVERA DRUG CO
- Practice address
- 111 Main St
Fort Valley, GA 31030-3701 - Phone
- (478) 825-5561
- Fax
- (478) 825-0934
- NPI assigned
- Mar 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Gary Alton Sheffield, PHARMACIST
- Title
- President
- Phone
- (478) 825-5561
National Provider Directory
Locations
111 Main St
Fort Valley, GA 31030
Phone (478) 825-5561
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 10944 | GA | Yes |
Addresses
Primary practice location
111 Main St
Fort Valley, GA 31030-3701
Mailing address
111 Main St
Fort Valley, GA 31030-3701
Phone (478) 825-5561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00021513A | Medicaid | GA |
Other providers in Fort Valley, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.