| NPI | 1114969342 |
|---|---|
| Doing Business As | VIDALIA PHARMACY INC |
| Entity Type | Organization |
| Authorized Contact | WALTER BEDINGFIELD Owner 912-537-4134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: GA 005032) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| 3336I0012X Pharmacy, Institutional Pharmacy | |
| 3336M0003X Pharmacy, Managed Care Organization Pharmacy | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2016-11-23 |