Healthcare Provider Details

I. General information

NPI: 1437804598
Provider Name (Legal Business Name): LAURE MARIE AGNES KASSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 ROYAL DR STE 175
ALPHARETTA GA
30022-2479
US

IV. Provider business mailing address

3155 ROYAL DR STE 175
ALPHARETTA GA
30022-2479
US

V. Phone/Fax

Practice location:
  • Phone: 770-496-7400
  • Fax:
Mailing address:
  • Phone: 770-496-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033469
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH033469
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: