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Contact Information

PULASKI STATE PRISON REGIONAL PHARMACY
373 UPPER RIVER RD
HAWKINSVILLE, GA31036-8898
 Phone: 478-783-6097
 Fax: 478-783-6252
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PULASKI STATE PRISON REGIONAL PHARMACY

NPI # 1902397995
LBN Legal business name PULASKI STATE PRISON REGIONAL PHARMACY
Authorized official RANDY GOODROE - (PHARMACY DIRECTOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/24/2018
Last updated 05/24/2018 - About 8 years ago
Identifiers
GA License # PHPR007792
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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