1922317908 NPI number — PRIMROSE PHARMACY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922317908 NPI number — PRIMROSE PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMROSE PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMROSE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922317908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8601 DUNWOODY PL
Provider Second Line Business Mailing Address:
SUITE146
Provider Business Mailing Address City Name:
SANDY SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30350-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-382-7064
Provider Business Mailing Address Fax Number:
770-998-7010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 DUNWOODY PL STE 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30350-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-382-7064
Provider Business Practice Location Address Fax Number:
770-998-7010
Provider Enumeration Date:
09/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LELAND
Authorized Official First Name:
MARGOT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, PHARMACY OPERATIONS
Authorized Official Telephone Number:
678-430-3804

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE009687 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2127085 . This is a "PK" identifier . This identifiers is of the category "OTHER".