Provider Demographics
NPI:1487719225
Name:LEE & PICKELS DRUGS STORE, INC.
Entity type:Organization
Organization Name:LEE & PICKELS DRUGS STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-263-4061
Mailing Address - Street 1:302 E SCREVEN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-2132
Mailing Address - Country:US
Mailing Address - Phone:229-263-4061
Mailing Address - Fax:229-263-5950
Practice Address - Street 1:302 E SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-2132
Practice Address - Country:US
Practice Address - Phone:229-263-4061
Practice Address - Fax:229-263-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0033643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000030709AMedicaid
GA000030709BMedicaid
GA000030709BMedicaid