NPIMap

Organization Active NPI

Ingles Markets Inc

Doing business as Ingles Pharmacy #488

  • Community/Retail Pharmacy
  • Clayton, GA
National Provider Identifier
1679724405
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009514 Issued in GA
Legal business name
INGLES MARKETS INC
Doing business as
Ingles Pharmacy #488
Practice address
176 Highway 441 N
Clayton, GA 30525-4207
Phone
(706) 782-3380
Fax
(706) 782-3381
NPI assigned
Oct 10, 2008
Last updated
Aug 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Mr. Stephen V Cucchi, RPH
Title
VP of Pharmacy
Phone
(828) 669-2941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE009514 GA Primary

Addresses

Primary practice location

176 Highway 441 N
Clayton, GA 30525-4207

Mailing address

PO Box 603941
Charlotte, NC 28260-3941
Phone (828) 669-2941

Other identifiers 2

IdentifierTypeStateIssuer
000971451GMedicaidGA
0116893MedicaidNC

Other names 1

  • Ingles Pharmacy #488 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20100930054361 GA DME Supplier - PharmacyDME Supplier - Grocery Store 5092867614 Practice locations: Clayton, GA

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2184959Ingles Markets, Inc (Ingles Pharmacy #488)176 Highway 441 North, Clayton, GA 30525Certificate of waiverMay 27, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Ingles Pharmacy #488176 Highway 441 N, Clayton, GA 30525-4207(706) 782-3380 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Sep 24, 2024

National Provider Directory

National Provider Directory

Locations

176 Highway 441 N
Clayton, GA 30525
Phone (706) 782-3380

Practitioners & affiliated clinicians

Practitioners 2

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": "1223596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1679724405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603941",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603941",
            "telephone_number": "828-669-2941",
            "fax_number": "828-669-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 HIGHWAY 441 N",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254207",
            "telephone_number": "706-782-3380",
            "fax_number": "706-782-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGLES MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-10",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "CUCCHI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "VP OF PHARMACY",
        "authorized_official_telephone_number": "828-669-2941",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000971451G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0116893",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ingles Pharmacy #488",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ingles Pharmacy #488",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clayton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.