NPIMap

Organization Active NPI

Hephzibah Pharmacy LLC

  • Community/Retail Pharmacy
  • Hephzibah, GA
National Provider Identifier
1851434336
Registry record updated Apr 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE004580 Issued in GA
Legal business name
HEPHZIBAH PHARMACY LLC
Doing business as
Hephzibah Pharmacy LLC
Practice address
4819 Windsor Spring Rd
Hephzibah, GA 30815-4848
Phone
(706) 592-4646
Fax
(706) 592-4618
NPI assigned
Feb 15, 2007
Last updated
Apr 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2016

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

Authorized official

Name
Kenneth Flakes, BS PHARMACY
Title
Owner
Phone
(706) 592-4646

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHRE004580 GA Primary

Addresses

Primary practice location

4819 Windsor Spring Rd
Hephzibah, GA 30815-4848

Mailing address

PO Box 265
Hephzibah, GA 30815-0265
Phone (706) 592-4646

Other identifiers 2

IdentifierTypeStateIssuer
2012942OtherPK
00037848AMedicaidGA

Other names 1

  • HEPHZIBAH PHARMACY LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461283200000",
    "number": "1851434336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 265",
            "city": "HEPHZIBAH",
            "state": "GA",
            "postal_code": "308150265",
            "telephone_number": "706-592-4646",
            "fax_number": "706-592-4618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4819 WINDSOR SPRING RD",
            "city": "HEPHZIBAH",
            "state": "GA",
            "postal_code": "308154848",
            "telephone_number": "706-592-4646",
            "fax_number": "706-592-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEPHZIBAH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2016-04-22",
        "status": "A",
        "authorized_official_last_name": "FLAKES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-592-4646",
        "authorized_official_credential": "BS PHARMACY"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE004580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012942",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00037848A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEPHZIBAH PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hephzibah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.