MEDICARE: GREDEL PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336L0003X	Long Term Care Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1740936327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREDEL PHARMACY

Provider Business Mailing Address
First Line	:	4095 ATLANTA HWY
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-1854
Country	:	US
Telephone Number	:	678-202-4804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4095 ATLANTA HWY
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141
Country	:	US
Telephone Number	:	678-202-4804
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	DR. ADAKU UGWU
Credential	:
Telephone Number	:	678-202-4804

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	05/19/2025

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Directions to “GREDEL PHARMACY ” Practice Location

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