Provider Demographics
NPI:1730369752
Name:LEDFORD RX EXPRESS INC
Entity type:Organization
Organization Name:LEDFORD RX EXPRESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-857-3300
Mailing Address - Street 1:103 HIGHWAY 48
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1506
Mailing Address - Country:US
Mailing Address - Phone:706-857-3300
Mailing Address - Fax:706-857-3303
Practice Address - Street 1:103 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1506
Practice Address - Country:US
Practice Address - Phone:706-857-3300
Practice Address - Fax:706-857-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1115080OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA00209921A4Medicaid
GA176262796BMedicaid