National Provider Identifier Database

MCINTOSH TRAIL CSB
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

MCINTOSH TRAIL CSB
1501A KALAMAZOO DR
GRIFFIN, GA30224-3919
Phone: 770-358-8250
Fax: 770-229-3223
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for MCINTOSH TRAIL CSB

NPI Number 1932368974
Legal business name
LBN
MCINTOSH TRAIL CSB
Authorized official PAMELA MCCOLLUM - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 06/05/2008
Last updated 06/11/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: PHRE005229
  • GA Medicaid: 000251666A
  • GA Other: 1123645 NCPDP

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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