NPIMap

Organization Active NPI

Adams Drug Store, Inc

  • Community/Retail Pharmacy
  • Cordele, GA
National Provider Identifier
1104950815
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE001060 Issued in GA
Legal business name
ADAMS DRUG STORE, INC
Practice address
408 B 16TH Ave E
Cordele, GA 31015
Phone
(229) 273-3433
Fax
(229) 273-0580
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

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

Authorized official

Name
Jonathan SinyardNPI 1720649957
Title
President
Phone
(229) 273-3433

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE001060 GA Primary

Addresses

Primary practice location

408 B 16TH Ave E
Cordele, GA 31015

Mailing address

PO Box 924
Cordele, GA 31010-0924
Phone (229) 273-3433

Other identifiers 2

IdentifierTypeStateIssuer
2012171OtherPK
00021106A4MedicaidGA

Other names 1

  • ADAMS DRUG STORE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930011609 GA DME Supplier - Pharmacy 7012036619 Practice locations: Cordele, GA
O20110926000516 GA Part B Supplier - Mass Immunization (Roster Biller Only) 7012036619 Practice locations: Cordele, GA

National Provider Directory

National Provider Directory

Locations

408 E 16th Ave
Ste B
Cordele, GA 31015
Phone (229) 273-3433

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1104950815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 924",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310100924",
            "telephone_number": "229-273-3433",
            "fax_number": "229-273-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 B 16TH AVE E",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "31015",
            "telephone_number": "229-273-3433",
            "fax_number": "229-273-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS DRUG STORE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "SINYARD",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-273-3433"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE001060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012171",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00021106A4",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADAMS DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADAMS DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cordele, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; 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.