Active NPI
Candace Lane Altman
- Pharmacist
- Pembroke, GA
National Provider Identifier
1790311785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH031811
- Practice address
- 546 W Bacon St
Pembroke, GA 31321-4648 - Phone
- (912) 653-1000
- Fax
- (912) 295-4667
- NPI assigned
- Mar 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH031811 | GA | Primary |
Addresses
Primary practice location
546 W Bacon St
Pembroke, GA 31321-4648
Mailing address
546 W Bacon St
Pembroke, GA 31321-4648
Phone (912) 653-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH031811 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quinate Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Southern Hometown Pharmacy
- Community/Retail Pharmacy
- Pembroke, GA
- NPI 1053891887
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584748800000",
"number": "1790311785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "546 W BACON ST",
"city": "PEMBROKE",
"state": "GA",
"postal_code": "313214648",
"telephone_number": "912-653-1000",
"fax_number": "912-295-4667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "546 W BACON ST",
"city": "PEMBROKE",
"state": "GA",
"postal_code": "313214648",
"telephone_number": "912-653-1000",
"fax_number": "912-295-4667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTMAN",
"first_name": "CANDACE",
"middle_name": "LANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-21",
"last_updated": "2020-03-21",
"certification_date": "2020-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH031811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.