Edison Pharmacy LLC

Key facts

NPI

1164570099

Entity type

Organization (NPI type 2)

Primary specialty

Community/Retail Pharmacy 3336C0003X

License

PHRE000311 (GA)

Legal business name

EDISON PHARMACY LLC

Practice address

19427 Hartford St
Edison, GA 39846-5627

Phone

(229) 835-2212

Fax

(229) 835-2572

NPI assigned

Jan 8, 2007

Organization subpart

No

Authorized official

Name

Edward F Reynolds, RPH

Title

Owner MGR

Phone

(229) 835-2212

Practitioners 1

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

• Jarrell Alan Ray, RPH Pharmacist · Edison, GA · NPI 1225584022
  NPD (past)

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• LANE DRUG CO Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 27, 2015.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1164570099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "EDISON",
            "state": "GA",
            "postal_code": "398460248",
            "telephone_number": "229-835-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19427 HARTFORD ST",
            "city": "EDISON",
            "state": "GA",
            "postal_code": "398465627",
            "telephone_number": "229-835-2212",
            "fax_number": "229-835-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISON PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER MGR",
        "authorized_official_telephone_number": "229-835-2212",
        "authorized_official_credential": "RPH"
    },
    "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": "PHRE000311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012347",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000030533A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LANE DRUG CO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edison, GA

• 464 Wellness Solutions LLC
• Albany Area Primary Health Care, Inc.
• Calhoun County Special Education
• Shemika L Cox, LPN
• Melissa Hunt Dozier, FNP
• Abigail Jessica Glass, FNP-C
• Stephanie Theresa James, LMSW
• Jarrell Alan Ray, RPH
• Gashebal Nicole Robinson, NP
• Tracy Alissa Rosenbaum, DO

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