His Care LLC
Organization Active NPI Community/Retail Pharmacy · Claxton, GA
NPI 1811097587 · NPPES record last updated Sep 22, 2016
Key facts
- NPI
- 1811097587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE008624 (GA)
- Legal business name
- HIS CARE LLC
- Practice address
- 305 E Long St
Claxton, GA 30417-1411 - Phone
- (912) 739-9393
- Fax
- (912) 739-9033
- NPI assigned
- Sep 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Anthony Hethcox, RPH
- Title
- Owner
- Phone
- (912) 739-9393
Practitioners 3
-
Anthony Chad Hethcox, R.PH.
-
Amber Durrence Wasson, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121204000244 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2163628447 | Practice locations: Claxton, GA |
National Provider Directory
Locations
305 E Long St
Claxton, GA 30417
Phone (912) 739-9393
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHRE008624 | GA | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
305 E Long St
Claxton, GA 30417-1411
Mailing address
PO Box 577
Claxton, GA 30417-0577
Phone (912) 739-9393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2014598 | Other | PK | |
| 944541867B | Medicaid | GA | |
| 944541867A | Medicaid | GA |
Other names
- THE DRUG STORE
Other providers in Claxton, GA
- Georgia Eye Institute, Inc.
- Georgia Home Health Care Hospice
- Health Link Medical Solutions
- Jesi Grace Hendricks
- Anthony Chad Hethcox
- Alayna Hodges
- Kyle Hollis
- Home Care AIDS, Inc.
- Hospitalmd of East Georgia Inc
- Hospitalmd of East Georgia Ip Inc
All providers in Claxton, 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 Sep 22, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.