NPIMap

Organization Active NPI

DJK 36 Inc

  • Community/Retail Pharmacy
  • Montezuma, GA
National Provider Identifier
1386949550
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE003393 Issued in GA
Legal business name
DJK 36 INC
Practice address
112 S Dooly St
Montezuma, GA 31063-1604
Phone
(478) 472-7561
Fax
(478) 472-5887
NPI assigned
Jan 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Authorized official

Name
Daniel Kiser
Title
Pharmacist in Charge/Owner
Phone
(478) 472-7561

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE003393 GA Primary

Addresses

Primary practice location

112 S Dooly St
Montezuma, GA 31063-1604

Mailing address

PO Box 250
Montezuma, GA 31063-0250
Phone (478) 472-7561

Other identifiers 2

IdentifierTypeStateIssuer
00927649AMedicaidGA
1161063OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Montezuma Drug Company Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1386949550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310630250",
            "telephone_number": "478-472-7561",
            "fax_number": "478-472-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S DOOLY ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631604",
            "telephone_number": "478-472-7561",
            "fax_number": "478-472-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DJK 36 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-20",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "KISER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE/OWNER",
        "authorized_official_telephone_number": "478-472-7561"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE003393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00927649A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1161063",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montezuma Drug Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montezuma, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; 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.