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Contact Information

AVERA DRUG CO
111 MAIN ST
FORT VALLEY, GA31030-3701
 Phone: 478-825-5561
 Fax: 478-825-0934
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
Indicates primary specialty

NPI Profile & details for AVERA DRUG CO · (Female)

NPI Number 1013986744
Status Active
Credentials
Entity Individual
Enumeration date 03/15/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # 10944
  • GA Medicaid 00021513A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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