NPIMap

Organization Active NPI

Pulaski State Prison Regional Pharmacy

  • Institutional Pharmacy
  • Hawkinsville, GA
National Provider Identifier
1902397995
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
PHPR007792 Issued in GA
Legal business name
PULASKI STATE PRISON REGIONAL PHARMACY
Practice address
373 Upper River Rd
Hawkinsville, GA 31036-8898
Phone
(478) 783-6097
Fax
(478) 783-6252
NPI assigned
May 24, 2018
Organization subpart
Yes
Parent organization
GEORGIA DEPARTMENT OF CORRECTIONSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Authorized official

Name
Randy Goodroe, RPH
Title
Pharmacy Director
Phone
(478) 783-6097

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X PHPR007792 GA Primary

Addresses

Primary practice location

373 Upper River Rd
Hawkinsville, GA 31036-8898

Mailing address

373 Upper River Rd
Hawkinsville, GA 31036-8898
Phone (478) 783-6097

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2261983Pulaski State Prison373 Upper River Road, Hawkinsville, GA 31036Certificate of waiverJun 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Georgia State Prison Regional Pharmacy9 organizations share this tax ID, including this one
Part of
Georgia State Prison Regional Pharmacy

Other organizations with this tax ID 8

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

Locations

373 Upper River Rd
Hawkinsville, GA 31036
Phone (478) 783-6097

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1902397995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 UPPER RIVER RD",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310368898",
            "telephone_number": "478-783-6097",
            "fax_number": "478-783-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 UPPER RIVER RD",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310368898",
            "telephone_number": "478-783-6097",
            "fax_number": "478-783-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI STATE PRISON REGIONAL PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DEPARTMENT OF CORRECTIONS",
        "enumeration_date": "2018-05-24",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "GOODROE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "478-783-6097",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "GA",
            "license": "PHPR007792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.