Active NPI
Quinate Pharmacy LLC
Doing business as Southern Hometown Pharmacy
- Community/Retail Pharmacy
- Pooler, GA
National Provider Identifier
1427518745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- QUINATE PHARMACY LLC
- Doing business as
- Southern Hometown Pharmacy
- Practice address
- 1557 Pooler Pkwy
Suite 400
Pooler, GA 31322 - Phone
- (912) 988-3005
- NPI assigned
- Mar 22, 2019
- Last updated
- May 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Tracey Leavitt
- Title
- Managing Partner
- Phone
- (912) 509-3330
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
1557 Pooler Pkwy
Suite 400
Pooler, GA 31322
Mailing address
1557 Pooler Pkwy Ste 400
Pooler, GA 31322-4389
Phone (912) 988-3005
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHRE010716 | Other | GA | STATE BOARD OF PHARMACY |
Other names 1
- Southern Hometown Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Quinate Pharmacy LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Southern Hometown Pharmacy
- Community/Retail Pharmacy
- Pembroke, GA
- NPI 1053891887
-
dba Gordon's Hometown Pharmacy
- Community/Retail Pharmacy
- Springfield, GA
- NPI 1386205524
Locations
3010 US Highway 80
Ste B
Bloomingdale, GA 31302
Phone (912) 988-1780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553212800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1590105600000",
"number": "1427518745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1557 POOLER PKWY STE 400",
"city": "POOLER",
"state": "GA",
"postal_code": "313224389",
"telephone_number": "912-988-3005",
"fax_number": "912-988-1674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1557 POOLER PKWY",
"address_2": "SUITE 400",
"city": "POOLER",
"state": "GA",
"postal_code": "31322",
"telephone_number": "912-988-3005"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "QUINATE PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-03-22",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A",
"authorized_official_last_name": "LEAVITT",
"authorized_official_first_name": "TRACEY",
"authorized_official_title_or_position": "MANAGING PARTNER",
"authorized_official_telephone_number": "912-509-3330",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF PHARMACY",
"identifier": "PHRE010716",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Southern Hometown Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pooler, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.