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Contact Information

VIDALIA PHARMACY INC
209 JACKSON ST
VIDALIA, GA30474-4713
 Phone: 912-537-4134
 Fax: 912-537-4169
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Managed Care Organization Pharmacy

3336M0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for VIDALIA PHARMACY INC

NPI Number 1114969342
LBN Legal business name VIDALIA PHARMACY INC
Authorized official WALTER BEDINGFIELD - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/12/2006
Last updated 11/23/2016 - About 10 years ago
Identifiers
GA License # 005032
GA Medicaid 0037749A
Other 2012881 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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