Healthcare Provider Details

I. General information

NPI: 1710823133
Provider Name (Legal Business Name): ALHARITH ABDEL-RAZZAQ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 HIGHWAY 92
ACWORTH GA
30102-2233
US

IV. Provider business mailing address

4978 ARBOR VIEW PKWY NW
ACWORTH GA
30101-3049
US

V. Phone/Fax

Practice location:
  • Phone: 770-529-9712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number035087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: