Malcolms Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE007181 Issued in GA

Legal business name

MALCOLMS DRUG STORE INC

Practice address

250 Peterson Ave S
Douglas, GA 31533-5237

Phone

(912) 384-1898

Fax

(912) 383-7109

NPI assigned

Dec 15, 2006

Organization subpart

No

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

Authorized official

Name

Prof. Stanley Smith, RPH

Title

President

Phone

(912) 384-1898

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Malcolms Drug Store 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.

• Malcolms Drug Store Inc

  • Pharmacy
  • Douglas, GA
  • NPI 1447362223
  NPD tax ID

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043372915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PETERSON AVE S",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315335237",
            "telephone_number": "912-384-1898",
            "fax_number": "912-383-7109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PETERSON AVE S",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315335237",
            "telephone_number": "912-384-1898",
            "fax_number": "912-383-7109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLMS DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-384-1898",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE007181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00031237A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "1109277",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Sharon Luke, FNP-C
• Torrey Mack
• W Eric Macleod, MD
• Magnolia House PCH, Inc
• Mahendra G Amin MD PC
• Malcolms Drug Store Inc
• Kera Ashlyn Malphus
• Elizabeth Martyn, NP
• Alfred Walter Mazur, M.D.
• Mary Kate McBee, APRN

• Community/Retail Pharmacy in Douglas, GA
• Providers in Douglas, 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 Aug 22, 2020; 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.