NPIMap

Organization Active NPI

City Pharmacy of Zebulon PC

  • Community/Retail Pharmacy
  • Zebulon, GA
National Provider Identifier
1437130374
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE005733 Issued in GA
Legal business name
CITY PHARMACY OF ZEBULON PC
Doing business as
City Pharmacy of Zebulon PC
Practice address
460 Thomaston St
Zebulon, GA 30295-3387
Phone
(770) 567-8844
Fax
(770) 567-5222
NPI assigned
Nov 8, 2005
Last updated
Sep 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Authorized official

Name
Kenneth GaskinsNPI 1043352271
Title
Pres and Owner
Phone
(770) 567-8844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE005733 GA Primary

Addresses

Primary practice location

460 Thomaston St
Zebulon, GA 30295-3387

Mailing address

PO Box 128
Zebulon, GA 30295-0128

Other identifiers 2

IdentifierTypeStateIssuer
00383325AMedicaidGA
1133420OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • CITY PHARMACY OF ZEBULON PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930094702 GA DME Supplier - Pharmacy 1052521622 Practice locations: Zebulon, GA
O20210301001409 GA Part B Supplier - Mass Immunization (Roster Biller Only) 1052521622 Practice locations: Zebulon, GA

National Provider Directory

National Provider Directory
Tax ID family
City Pharmacy of Zebulon PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1437130374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "ZEBULON",
            "state": "GA",
            "postal_code": "302950128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 THOMASTON ST",
            "city": "ZEBULON",
            "state": "GA",
            "postal_code": "302953387",
            "telephone_number": "770-567-8844",
            "fax_number": "770-567-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY PHARMACY OF ZEBULON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRES AND OWNER",
        "authorized_official_telephone_number": "770-567-8844"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE005733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00383325A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1133420",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITY PHARMACY OF ZEBULON PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zebulon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.