Active NPI
Magnolia Drug Co Inc
- Community/Retail Pharmacy
- Homerville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MAGNOLIA DRUG CO INC
- Practice address
- 112 N Church St Ste a
Homerville, GA 31634-2448 - Phone
- (912) 470-7277
- Fax
- (912) 244-6679
- NPI assigned
- Sep 13, 2022
- Last updated
- May 17, 2023
- 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
- Dr. Matthew Tanner, PHARMD
- Title
- Ceo
- Phone
- (912) 422-3631
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
112 N Church St Ste a
Homerville, GA 31634-2448
Mailing address
PO Box 608
Pearson, GA 31642-0608
Phone (912) 422-3631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230523001493 | GA | Part B Supplier - Pharmacy | 5890151583 | Practice locations: Homerville, GA |
National Provider Directory
National Provider Directory- Tax ID family
- Magnolia Drug Co Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Homerville, GA
- NPI 1972307734
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Pharmacist
- Pearson, GA
- NPI 1144865056
-
- Pharmacist
- Waycross, GA
- NPI 1376132464
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1684281600000",
"number": "1861114217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 608",
"city": "PEARSON",
"state": "GA",
"postal_code": "316420608",
"telephone_number": "912-422-3631",
"fax_number": "912-422-6104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 N CHURCH ST STE A",
"city": "HOMERVILLE",
"state": "GA",
"postal_code": "316342448",
"telephone_number": "912-470-7277",
"fax_number": "912-244-6679"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAGNOLIA DRUG CO INC",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-13",
"last_updated": "2023-05-17",
"certification_date": "2023-05-17",
"status": "A",
"authorized_official_last_name": "TANNER",
"authorized_official_first_name": "MATTHEW",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "912-422-3631",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homerville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.