Mark Gregory Pam – Pharmacist in Cochran, GA

Key facts

NPI: 1306568258
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: 15622 (GA)
Practice address: 202 NE Dykes Street
Cochran, GA 31014
Phone: (478) 934-9431
NPI assigned: Sep 16, 2022
Sex: Male
Sole proprietor: Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Georgia CVS Pharmacy L.L.C Pharmacy · Pooler, GA · NPI 1578009130

NPD (past)
Georgia CVS Pharmacy, L.L.C. Pharmacy · Cochran, GA · NPI 1700989548

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
15622	GA	MD	Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Georgia CVS Pharmacy L.L.C		Past since Sep 20, 2022	Accepting new patients
Georgia CVS Pharmacy, L.L.C.		Past since Sep 20, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	15622	GA	Yes

Addresses

Primary practice location

202 NE Dykes Street
Cochran, GA 31014

Mailing address

202 North East Dykes Street
Cochran, GA 31014
Phone (478) 934-9431

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 16, 2022.

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1306568258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 NORTH EAST DYKES STREET",
            "city": "COCHRAN",
            "state": "GA",
            "postal_code": "31014",
            "telephone_number": "478-934-9431",
            "fax_number": "478-934-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 NE DYKES STREET",
            "city": "COCHRAN",
            "state": "GA",
            "postal_code": "31014",
            "telephone_number": "478-934-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAM",
        "first_name": "MARK",
        "middle_name": "GREGORY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-16",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "15622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cochran, GA

All providers in Cochran, GA · Pharmacist in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.