Ingles Markets Inc
Organization Active NPI Community/Retail Pharmacy · Clarkesville, GA
NPI 1124033071 · NPPES record last updated Aug 15, 2019
Key facts
- NPI
- 1124033071
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE009021 (GA)
- Legal business name
- INGLES MARKETS INC
- Practice address
- 199 E Louise St
Clarkesville, GA 30523 - Phone
- (706) 754-3933
- Fax
- (706) 754-3974
- NPI assigned
- Jul 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Stephen V Cucchi, RPH
- Title
- VP of Pharmacy
- Phone
- (828) 669-2941
Other NPIs on the same Medicare enrollment 33
Practitioners 4
-
Tracy S. English, RPH
-
Beverly Deann Wilson, PHARM D
-
Colleen M. Colegrove, R.PH.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2184987 | Ingles Markets, Inc (Ingles Pharmacy #428) | Certificate of waiver | May 27, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Ingles Markets Pharmacy #428 |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090716000635 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092867614 |
35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Elberton, GA; Ellijay, GA; Flowery Branch, GA; Forsyth, GA; Gray, GA; Griffin, GA; Hartwell, GA; Hiawassee, GA… |
| O20100930023773 | GA | DME Supplier - Pharmacy |
5092867614 | Practice locations: Clarkesville, GA |
National Provider Directory
Locations
199 E Louise St
Clarkesville, GA 30523
Phone (706) 754-3933
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHRE009021 | GA | Yes |
Addresses
Primary practice location
199 E Louise St
Clarkesville, GA 30523
Mailing address
PO Box 603941
Charlotte, NC 28260-3941
Phone (828) 669-2941
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151133852A | Medicaid | GA | |
| 1154296 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- INGLES PHARMACY #428
Other providers in Clarkesville, GA
- Heartfelt in-Home Care of Georgia LLC
- Ronand Eugene Henderson
- Hailey Hoopaugh
- Natalie Erin Hunter
- In Touch Counseling, LLC
- It'S About Independence
- J Kenneth Weldon, Jr, DMD LLC
- James H Farmerdmd PC
- Stephen W Jarrard
- Amber Kingry
All providers in Clarkesville, 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 Aug 15, 2019. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.