McCaysville Drug Center Inc
Organization Active NPI Community/Retail Pharmacy · MC Caysville, GA
NPI 1295849180 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1295849180
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE006444 (GA)
- Legal business name
- MCCAYSVILLE DRUG CENTER INC
- Practice address
- 131 Blue Ridge Dr
MC Caysville, GA 30555-2767 - Phone
- (706) 492-4126
- Fax
- (706) 492-5902
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Houston Rogers, PHARMD
- Title
- Owner
- Phone
- (706) 492-4126
Subparts reporting this organization as parent 1
Practitioners 1
-
Houston L Rogers Jr., PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110314000551 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 9436279346 | Practice locations: MC Caysville, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHRE006444 | GA | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
131 Blue Ridge Dr
MC Caysville, GA 30555-2767
Mailing address
PO Box 338
McCaysville, GA 30555
Phone (706) 492-4126
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2012586 | Other | PK | |
| 00399011A | Medicaid | GA |
Other names
- MCCAYSVILLE DRUG CENTER INC
Other providers in MC Caysville, GA
- Ashley Blomeley
- Jessica Megan Foster
- McCaysville Drug Center Inc
- Houston L Rogers Jr.
- Shirley Ann Spooner
All providers in MC Caysville, 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 Jul 19, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.