Ingles Markets Inc.
Organization Active NPI Community/Retail Pharmacy · Cornelia, GA
NPI 1669754255 · NPPES record last updated Aug 14, 2019
Key facts
- NPI
- 1669754255
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE009778 (GA)
- Legal business name
- INGLES MARKETS INC.
- Practice address
- 199 Habersham County Shopping Ctr
Cornelia, GA 30531-3412 - Phone
- (706) 778-8099
- Fax
- (706) 778-8100
- NPI assigned
- Sep 9, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Stephen V Cucchi, RPH
- Title
- VP of Pharmacy
- Phone
- (828) 669-2941
Other NPIs on the same Medicare enrollment 33
Practitioners 4
-
Tarek John Kerbage, RPH
-
Jessica Hardeman McDonald, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2184949 | Ingles Markets, Inc (Ingles Pharmacy #061) | Certificate of waiver | May 27, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Ingles Pharmacy #061 |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090716000635 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5092867614 |
35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Elberton, GA; Ellijay, GA; Flowery Branch, GA; Forsyth, GA; Gray, GA; Griffin, GA; Hartwell, GA; Hiawassee, GA… |
| O20120907000401 | GA | DME Supplier - Pharmacy |
5092867614 | Practice locations: Cornelia, GA |
National Provider Directory
Locations
199 Habersham County Shopping Ctr
Cornelia, GA 30531
Phone (706) 778-8099
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHRE009778 | GA | Yes |
Addresses
Primary practice location
199 Habersham County Shopping Ctr
Cornelia, GA 30531-3412
Mailing address
PO Box 603941
Charlotte, NC 28260-3941
Phone (828) 669-2941
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003116666A | Medicaid | GA |
Other names
- Ingles Pharmacy #061
Other providers in Cornelia, GA
- Harrison Macnellis, DMD, LLC
- Kelley Robin Hart
- Troy Alan Hayward
- Health Advocate Portable Practitioner to You LLC
- Thanh Duy Hoang
- Ralph L Jackson
- James Monroe Colston
- Rosmery Del Carmen Jimenez de Rodriguez
- Kimberly B Kaminski
- Kathryn Kaplan Kelly
All providers in Cornelia, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.