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Lee Arrendale State Prison Pharmacy

Organization Active NPI Institutional Pharmacy · Alto, GA

NPI 1851882013 · NPPES record last updated May 23, 2018

Key facts

NPI
1851882013
Entity type
Organization (NPI type 2)
Primary specialty
Institutional Pharmacy 3336I0012X
License
PHPR006157 (GA)
Legal business name
LEE ARRENDALE STATE PRISON PHARMACY
Practice address
2023A Gainesville Hwy
Alto, GA 30510-4435
Phone
(706) 776-0661
Fax
(706) 776-4982
NPI assigned
May 23, 2018
Organization subpart
Yes
Parent organization (as reported)
GEORGIA DEPARTMENT OF CORRECTIONS

Authorized official

Name
Tom Poole, RPH
Title
Pharmacy Director
Phone
(706) 776-0661

Corporate family (same tax ID) 8

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2266599Lee Arrendale State Prison
2023 Gainesville Highway S, Alto, GA 30510		Certificate of waiverAug 11, 2026

National Provider Directory

Tax ID family
Georgia State Prison Regional Pharmacy (9 organizations share this tax ID)
Part of
Georgia State Prison Regional Pharmacy

Locations

2023 Gainesville Hwy
#A
Alto, GA 30510
Phone (706) 776-0661

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X PHPR006157 GA Yes

Addresses

Primary practice location

2023A Gainesville Hwy
Alto, GA 30510-4435

Mailing address

PO Box 709
Alto, GA 30510-0709
Phone (706) 776-0661

Other providers in Alto, GA

All providers in Alto, GA · Institutional Pharmacy in Georgia

Sources for this page

Verify at the official NPI Registry.