OLDE TIME PHARMACY AT SIXES LLC (NPI# 1912208539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912208539 |
| Entity Type | Organization |
| Organization Name | OLDE TIME PHARMACY AT SIXES LLC |
| Other Organization Name | OLDE TIME PHARMACY AT SIXES, LLC |
| Practice Address |
684 Sixes Rd Ste 105 Holly Springs GA 30115-8720 |
| Mailing Address |
684 Sixes Rd Suite 105 Holly Springs GA 30115-8721 |
| Practice Telephone | 7707830483 |
| Mailing Telephone | 7707830483 |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2010-12-01 |
| Authorized Official Name | SHAD SUTHERLAND (OWNER) |
| Authorized Official Telephone | 7707830483 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHRE009711 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 1160643 | 01 |
| Other Name | Type Code |
|---|---|
| Olde Time Pharmacy at Sixes, LLC | Doing Business As Name - Organization |
| Street Address |
684 SIXES RD STE 105 |
| City | HOLLY SPRINGS |
| State | GA |
| Zip Code | 30115-8720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750474987 | Monika S Yadav | Internal Medicine | 684 Sixes Rd Ste 105, Holly Springs, GA 30115-8720 | 2006-10-02 |
| 1386089720 | Daniel Mcmahon | Family Medicine | 684 Sixes Rd Ste 105, Holly Springs, GA 30115-8720 | 2013-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497364806 | Amanda Arbogast | Speech-Language Pathologist | 610 Royal Crest Court, Canton, GA 30115 | 2020-07-31 |
| 1033754163 | Kelly Marie Shirley | Nurse Practitioner | 450 Northside Cherokee Blvd., Radiology Dept., Canton, GA 30115 | 2019-11-13 |
| 1700394319 | Jennifer Lynn Davenport | Nurse Practitioner | 684 Sixes Rd Ste 125, Holly Springs, GA 30115 | 2018-01-17 |
| 1851717961 | Wal-mart Stores East, Lp | Technician/Technologist | 2200 Holly Springs Pkey, Holly Springs, GA 30115 | 2014-03-13 |
| 1194148502 | Julia Bedingfield Reid | Pharmacist | 450 Northside Cherokee Blvd Ste T20, Canton, GA 30115 | 2014-01-22 |
| 1447597992 | America's Best Contacts & Eyeglasses | Technician/Technologist | 2030 Cumming Highway, Suite 106, Canton, GA 30115 | 2013-01-03 |
| 1679821193 | Jill M Decorso | Speech-Language Pathologist | 4280 Hickory Flat Hwy, Ste 108, Canton, GA 30115 | 2012-08-15 |
| 1306113378 | Sidney Boyd Collier IIi | Pharmacist | 6111 Hickory Flat Highway, Canton, GA 30115 | 2011-11-18 |
| 1174804702 | Rayllensons Itacy | Physician Assistant | 2020 Cumming Highway, Suite 102, Canton, GA 30115 | 2011-09-09 |
| 1245534346 | Kim M. Mcmillan | Counselor | 154 Lakeside Drive, Canton, GA 30115 | 2011-01-04 |
| Find all providers in zip 30115 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932104650 | Tyson Drugs Inc | Pharmacy | 530 J M Ash Dr, Holly Springs, MS 38635-3238 | 2005-06-17 |
| 1952773517 | Wmc Pharmacy | Pharmacy | 1938 Crescent Meadows Dr, Holly Springs, MS 38635-7419 | 2015-10-22 |
| 1023495272 | Holly Springs Pharmacy LLC | Pharmacy | 648 Holly Springs Rd, Holly Springs, NC 27540-9030 | 2015-04-27 |
| 1760662290 | Robinson's Health Mart | Pharmacy | 108 E College Ave, Holly Springs, MS 38635-3002 | 2007-11-13 |
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|---|---|---|---|---|
| 1154922441 | Southern Pharmacy Group LLC | Pharmacy | 110 Allison St., Jesup, GA 31545 | 2020-11-04 |
| 1184225526 | Svdp Georgia Community Pharmacy LLC | Pharmacy | 2050 Chamblee Tucker Rd Ste C, Chamblee, GA 30341-3343 | 2020-11-03 |
| 1194325860 | Panola Pharmacy LLC | Pharmacy | 2348 Panola Rd Unit C, Lithonia, GA 30058-5406 | 2020-10-30 |
| 1659971539 | Bob and Jeff's Hometown Pharmacy of Thomasville, LLC | Pharmacy | 309 Smith Ave, Thomasville, GA 31792-5534 | 2020-10-29 |
| 1679171979 | Dfg LLC | Pharmacy | 638 Historic Hwy 441 Suite A, Demorest, GA 30530 | 2020-10-09 |
| 1033716915 | Au Medical Center, Inc. | Pharmacy | 818 Saint Sebastian Way Ste 402, Augusta, GA 30901-2654 | 2020-10-05 |
| 1043817208 | Mlk Pharmacy2.0 | Pharmacy | 2457 Mlk Jr Dr Sw Ste A, Atlanta, GA 30311-1712 | 2020-10-01 |
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1205446341 | Sunny Pharmacy | Pharmacy | 5364 Jonesboro Rd, Lake City, GA 30260-3557 | 2020-08-04 |
| 1841818044 | Hospital Authority of Miller County | Pharmacy | 213 Delores Street, Colquitt, GA 39837 | 2020-07-14 |
| Find all providers with the same taxonomy | ||||
| City | HOLLY SPRINGS |
| Zip Code | 30115 |
Please comment or provide details below to improve the information on OLDE TIME PHARMACY AT SIXES LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.