SOUTHEASTERN PHARMACY LLC (NPI# 1336165547) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336165547 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN PHARMACY LLC |
| Other Organization Name | ALTAMA PHARMACY |
| Practice Address |
5711 Altama Ave Unit G Brunswick GA 31525-2240 |
| Mailing Address |
5711 Altama Ave Suite G Brunswick GA 31525-2240 |
| Practice Telephone | 9122642622 |
| Practice Fax Number | 9122641392 |
| Mailing Telephone | 9122642622 |
| Mailing Fax Number | 9122641392 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-02-17 |
| Authorized Official Name | GEORGE MICHAEL LEWIS (OWNER) |
| Authorized Official Telephone | 9122642622 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
002733 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000028256A | 05 | |
| GA | NABP | 1106930 | 01 |
| GA | 1106930 | 05 |
| Other Name | Type Code |
|---|---|
| altama discount pharmacy | Doing Business As Name - Organization |
| ALTAMA PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811540867 | Southeastern Pharmacy LLC | Pharmacy | 5711 Altama Ave Ste G, Brunswick, GA 31525-2200 | 2019-07-18 |
| Street Address |
5711 ALTAMA AVE UNIT G |
| City | BRUNSWICK |
| State | GA |
| Zip Code | 31525-2240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568670933 | Elizabeth Jeter Thompson | Pharmacist | 5711 Altama Ave, Unit J, Brunswick, GA 31525-2240 | 2007-05-18 |
| 1598892788 | Gary Brandon Bailey Jr. | Pharmacist | 5711 Altama Ave, Suite J, Brunswick, GA 31525-2240 | 2007-02-27 |
| 1790844462 | Lon Wallda Lewis | Pharmacist | 5711 Altama Ave, Suite J, Brunswick, GA 31525-2240 | 2006-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905990 | Jonathon Wesley Capps | Physician Assistant | 1111 Glynco Pkwy Bldg 1, Ste 10, Brunswick, GA 31525 | 2018-06-14 |
| 1366993628 | Hands Down Muscle Restoration, Inc | Homeopath | 1212 Chapel Crossing Road, Brunswick, GA 31525 | 2016-10-20 |
| 1619424173 | Jebediah S Christy Dds - Brunswick Pllc | Dentist | 11455 Canal Crossing, Brunswick, GA 31525 | 2016-09-01 |
| 1831545508 | Heller Family Medicine, LLC | General Practice | 208 Scranton Connector Ste 120, Brunswick, GA 31525 | 2016-05-11 |
| 1437525391 | Natisha Danielle Hill | Occupational Therapy Assistant | 138 Wingefield Commons Drive, Brunswick, GA 31525 | 2015-08-14 |
| 1811269632 | Solar Family Practice | Family Medicine | 122 Scranton Connector, Suite 112, Brunswick, GA 31525 | 2012-02-09 |
| 1700187895 | Chetan Patel | Pharmacist | 12 Woodfall Ct, Brunswick, GA 31525 | 2010-11-05 |
| 1194914275 | Dialysis of Golden Isles, LLC | Clinic/Center | 475 Gateway Center Blvd, Brunswick, GA 31525 | 2007-10-15 |
| 1902939325 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 111 Frazier Street, Brunswick, GA 31525 | 2007-03-14 |
| 1609909498 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 Frazier Road, Brunswick, GA 31525 | 2007-03-13 |
| Find all providers in zip 31525 | ||||
| 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 |
|---|---|---|---|---|
| 1497272728 | Weis Markets, Inc. | Pharmacy | 1201 Dutchman's Creek Drive, Brunswick, MD 21716 | 2017-08-28 |
| 1710359864 | Genoa Healthcare, LLC | Pharmacy | 600 Coastal Village Dr Rm 107, Brunswick, GA 31520-1973 | 2015-10-28 |
| 1619000684 | Marc Glassman Inc | Pharmacy | 3303 Center Rd, Brunswick, OH 44212-3830 | 2007-03-13 |
| 1760585418 | Georgia Cvs Pharmacy LLC | Pharmacy | 1709 Gloucester St, Brunswick, GA 31520-6902 | 2006-09-07 |
| 1851494512 | Georgia Cvs Pharmacy LLC | Pharmacy | 5421 New Jesup Hwy, Brunswick, GA 31523-1137 | 2006-09-07 |
| 1952316721 | City Drug Store | Pharmacy | 1402 Newcastle St, Brunswick, GA 31520-7018 | 2006-07-30 |
| 1871508895 | Walgreen Co | Pharmacy | 1337 Pearl Rd, Brunswick, OH 44212-2807 | 2006-07-29 |
| 1942215058 | Walgreen Co | Pharmacy | 4575 Altama Ave, Brunswick, GA 31520-3008 | 2006-07-29 |
| 1538683529 | Walgreen Co | Pharmacy | 156 Maine St, Brunswick, ME 04011-2007 | 2017-08-01 |
| 1174947907 | Samson Merger Sub, LLC | Pharmacy | 341 Venture Dr, Brunswick, GA 31525-9723 | 2014-02-14 |
| Find all providers in BRUNSWICK | ||||
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| 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.