Provider Demographics
NPI:1053146456
Name:MEDVILLE PHARMACY AND COMPOUNDING
Entity type:Organization
Organization Name:MEDVILLE PHARMACY AND COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:U
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-500-6973
Mailing Address - Street 1:2205 E OGLETHORPE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-2939
Mailing Address - Country:US
Mailing Address - Phone:229-500-6973
Mailing Address - Fax:229-500-6974
Practice Address - Street 1:2205 E OGLETHORPE BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2939
Practice Address - Country:US
Practice Address - Phone:229-500-6973
Practice Address - Fax:229-500-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy