Villa Rica RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE010412 Issued in GA

Legal business name

VILLA RICA RX LLC

Doing business as

Villa Rica Drugs

Practice address

222 West Wilson Street
Villa Rica, GA 30180

Phone

(770) 456-4663

Fax

(770) 456-4661

NPI assigned

Jun 9, 2011

Last updated

Jun 26, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Colton Harold Blackmon, PHARM D

Title

Owner

Phone

(770) 456-4663

Specialties & licenses 2

Addresses

Other names 1

• VILLA RICA DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1619262433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WEST WILSON STREET",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "30180",
            "telephone_number": "770-456-4663",
            "fax_number": "770-456-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 WEST WILSON STREET",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "30180",
            "telephone_number": "770-456-4663",
            "fax_number": "770-456-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLA RICA RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "COLTON",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-456-4663",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009763",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLA RICA DRUGS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VILLA RICA DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Villa Rica Behavioral Health PC
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• Villa Rica Family Dental
• Villa Rica OB GYN Inc
• Villa Rica RX LLC (Villa Rica Drugs LTC)
• Richard Brent Wadsworth Jr., LAPC
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2732)
• Wal-Mart Stores East, LP (Vision Center 30-2732)
• Walgreen Co (Rite Aid #11756)
• Walgreen Co (Walgreens #11491)

• Community/Retail Pharmacy in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.