Provider Demographics
NPI:1952467862
Name:THOMASVILLE PHARMACY SERVICES INC
Entity type:Organization
Organization Name:THOMASVILLE PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:229-226-2203
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-0861
Mailing Address - Country:US
Mailing Address - Phone:229-226-2203
Mailing Address - Fax:229-226-0980
Practice Address - Street 1:519 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-3105
Practice Address - Country:US
Practice Address - Phone:229-226-2203
Practice Address - Fax:229-226-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1151682OtherNCPDP
GA157261115AMedicaid
GA157261115AMedicaid