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Contact Information

AUTRY STATE PRISON PHARMACY
3178 MOUNT ZION CHURCH RD
PELHAM, GA31779
 Phone: 229-294-6786
 Fax: 229-294-6788
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for AUTRY STATE PRISON PHARMACY

NPI Number 1831689728
LBN Legal business name AUTRY STATE PRISON PHARMACY
Authorized official DEENA GAINOUS - (PHARMACY DIRECTOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/16/2018
Last updated 05/23/2018 - About 8 years ago
Identifiers
GA License # PHPR007470
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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