NPIMap

Organization Active NPI

Midcity Pharmacy

  • Pharmacist
  • Canton, GA
National Provider Identifier
1619044914
Registry record updated Jul 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
8181 Issued in GA
Legal business name
MIDCITY PHARMACY
Practice address
196 E Main St
Canton, GA 30114-2707
Phone
(770) 479-5533
Fax
(770) 479-5534
NPI assigned
Nov 29, 2006
Last updated
Jul 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2008

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

Authorized official

Name
Mr. William Grady Cagle Jr., PHARMISTNPI 1861573263
Title
Owner
Phone
(770) 479-5533

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
Durable Medical Equipment & Medical Supplies 332B00000X 332B00000X NU
Pharmacist 183500000X 8181 GA Primary

Addresses

Primary practice location

196 E Main St
Canton, GA 30114-2707

Mailing address

196 E Main St
Canton, GA 30114-2707
Phone (770) 479-5533

Other identifiers 4

IdentifierTypeStateIssuer
1102401OtherGANABP
00032051BMedicaidGA
00032051AMedicaidGA
87BBBCSOtherMEDICARE PART B

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070306000051 GA Part B Supplier - Other 9335242775 Practice locations: Canton, GA
O20100930018533 GA DME Supplier - PharmacyDME Supplier - Medical Supply Company 9335242775 Practice locations: Canton, GA

National Provider Directory

National Provider Directory
Tax ID family
Midcity Pharmacy2 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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216425600000",
    "number": "1619044914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 E MAIN ST",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142707",
            "telephone_number": "770-479-5533",
            "fax_number": "770-479-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 E MAIN ST",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142707",
            "telephone_number": "770-479-5533",
            "fax_number": "770-479-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDCITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-07-19",
        "status": "A",
        "authorized_official_last_name": "CAGLE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GRADY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-479-5533",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHARMIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": "332B00000X",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "8181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1102401",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00032051B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00032051A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "87BBBCS",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2008; 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.