Healthcare Provider Details

I. General information

NPI: 1255645669
Provider Name (Legal Business Name): SIP INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 MCGINNIS FERRY RD STE 102
ALPHARETTA GA
30005-3669
US

IV. Provider business mailing address

6375 MCGINNIS FERRY RD SUITE 102
ALPHARETTA GA
30005-3617
US

V. Phone/Fax

Practice location:
  • Phone: 678-869-6000
  • Fax: 678-869-6002
Mailing address:
  • Phone: 678-869-6000
  • Fax: 678-869-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114322
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHRE009662
License Number StateGA

VIII. Authorized Official

Name: VIMAL PARAG
Title or Position: PRESIDENT
Credential:
Phone: 678-756-0165