NPIMap

Organization Active NPI

River Edge Recovery Center Pharmacy

  • Pharmacy
  • Macon, GA
National Provider Identifier
1720538960
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHRE007084 Issued in GA
Legal business name
RIVER EDGE RECOVERY CENTER PHARMACY
Practice address
3575 Fulton Mill Rd
Macon, GA 31206-5125
Phone
(478) 803-7650
NPI assigned
Oct 12, 2016
Organization subpart
Yes
Parent organization
RIVER EDGE BEHAVIORAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Authorized official

Name
Bryan Layman, RPH
Title
Pharmacy Director
Phone
(478) 803-7650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHRE007084 GA Primary

Addresses

Primary practice location

3575 Fulton Mill Rd
Macon, GA 31206-5125

Mailing address

175 Emery Hwy
Macon, GA 31217-3692

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
11D0946620River Edge Recovery Center3575 Fulton Mill Rd, Macon, GA 31206Certificate of waiverMay 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
River Edge Behavorial H77 organizations share this tax ID, including this one
Part of
River Edge Behavorial H

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1720538960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 EMERY HWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 FULTON MILL RD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312065125",
            "telephone_number": "478-803-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER EDGE RECOVERY CENTER PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVER EDGE BEHAVIORAL HEALTH CENTER",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "LAYMAN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "478-803-7650",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE007084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.