Hogansville Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE006611 Issued in GA

Legal business name

HOGANSVILLE PHARMACY INC

Doing business as

Hogansville Pharmacy Inc

Practice address

300 E Main St
Hogansville, GA 30230-1134

Phone

(706) 637-8683

NPI assigned

Dec 28, 2006

Last updated

Mar 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phil Waldrop

Title

Owner

Phone

(706) 637-8683

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• HOGANSVILLE PHARMACY INC Doing business as

Locations

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1184780074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MAIN ST",
            "city": "HOGANSVILLE",
            "state": "GA",
            "postal_code": "302301134",
            "telephone_number": "706-637-8683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E MAIN ST",
            "city": "HOGANSVILLE",
            "state": "GA",
            "postal_code": "302301134",
            "telephone_number": "706-637-8683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOGANSVILLE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "WALDROP",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-637-8683"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE006611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000190792A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1123924",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HOGANSVILLE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandi Cameron, LPC
• Andrea Marie Carroll, LPC, MS
• Chantel Colmer, D.C.
• Gregory E. Freeman, DDS
• Amy Claire Griffith, MS, ATC/L, CSCS
• Individual
• Cowenda Shavonne Jefferson, MA LPC NCC CCAADC
• Nicole Joseph
• Vishwas S Kadam, MD
• Brenton Knowlton, RPH

• Community/Retail Pharmacy in Hogansville, GA
• Providers in Hogansville, 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 Mar 16, 2012; 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.