Active NPI
Magnolia Manor Pharmacy
- Long Term Care Pharmacy
- Americus, GA
National Provider Identifier
1821145319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- 002260
- Legal business name
- MAGNOLIA MANOR PHARMACY
- Practice address
- 2001 S Lee St
Americus, GA 31709 - Phone
- (229) 924-9352
- Fax
- (229) 931-5956
- NPI assigned
- Jan 5, 2007
- Reactivated
- Jan 2, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. J Andrew Hill Jr., RPH PHARMACIST
- Title
- President
- Phone
- (478) 783-1515
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | 002260 | GA | Primary |
Addresses
Primary practice location
2001 S Lee St
Americus, GA 31709
Mailing address
2001 South Lee St
Americus, GA 31709
Phone (229) 924-9352
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1147950 | Other | GA | NCPDP |
| 00040785A | Medicaid | GA | |
| 1147950 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
National Provider Directory
National Provider Directory- Tax ID family
- Magnolia Manor Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Americus, GA
- NPI 1588647754
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208304000000",
"number": "1821145319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 SOUTH LEE ST",
"city": "AMERICUS",
"state": "GA",
"postal_code": "31709",
"telephone_number": "229-924-9352",
"fax_number": "229-931-5956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 S LEE ST",
"city": "AMERICUS",
"state": "GA",
"postal_code": "31709",
"telephone_number": "229-924-9352",
"fax_number": "229-931-5956"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGNOLIA MANOR PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-05",
"last_updated": "2008-04-16",
"deactivation_date": "2007-01-08",
"reactivation_date": "2008-01-02",
"status": "A",
"authorized_official_last_name": "HILL",
"authorized_official_first_name": "J",
"authorized_official_middle_name": "ANDREW",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "478-783-1515",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "RPH PHARMACIST"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "GA",
"license": "002260",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "1147950",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00040785A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1147950",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Americus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.