Hines Prescription Shop, Inc.
Organization Active NPI Community/Retail Pharmacy · Barnesville, GA
NPI 1679529309 · NPPES record last updated Mar 19, 2021
Key facts
- NPI
- 1679529309
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE006093 (GA)
- Legal business name
- HINES PRESCRIPTION SHOP, INC.
- Practice address
- 302 College Dr
Barnesville, GA 30204-1602 - Phone
- (770) 358-2266
- Fax
- (770) 358-4497
- NPI assigned
- May 25, 2006
- Organization subpart
- No
Authorized official
- Name
- John Tyler Young
- Title
- President
- Phone
- (770) 358-2266
Practitioners 1
-
John Tyler Young, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2234841 | Hines Prescription Shop | Certificate of waiver | Sep 1, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Hines Prescription Shop Inc |
Immunosuppressive Drugs|Nebulizer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (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 |
|---|---|---|---|---|
| O20100930091295 | GA | DME Supplier - Pharmacy | 0244351310 | Practice locations: Barnesville, GA |
| O20170127002624 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 0244351310 | Practice locations: Barnesville, GA |
National Provider Directory
Locations
302 College Dr
Barnesville, GA 30204
Phone (770) 358-2266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHRE006093 | GA | Yes |
Addresses
Primary practice location
302 College Dr
Barnesville, GA 30204-1602
Mailing address
302 College Dr
Barnesville, GA 30204-1602
Phone (770) 358-2266
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2013044 | Other | PK | |
| 00029323A | Medicaid | GA |
Other names
- HINES PRESCRIPTION SHOP
Other providers in Barnesville, GA
- Amber Hall
- Stephanie Brianna Hankinson
- Health Services of Central Georgia, Inc
- Kristina Henderson
- Heritage Inn of Barnesville LLC
- Ashley Holt
- Wesley Michael Hubbard
- Ingles Markets Inc
- Brittany Johnson
- Fantasia Kaul
All providers in Barnesville, 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 Mar 19, 2021. 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.