Provider Demographics
NPI:1053148700
Name:MONTICELLO DRUGS, INC
Entity type:Organization
Organization Name:MONTICELLO DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT-ADV
Authorized Official - Phone:706-468-6836
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-0435
Mailing Address - Country:US
Mailing Address - Phone:706-468-6836
Mailing Address - Fax:706-468-1973
Practice Address - Street 1:679 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1371
Practice Address - Country:US
Practice Address - Phone:706-468-6836
Practice Address - Fax:706-468-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy