Healthcare Provider Details

I. General information

NPI: 1568273423
Provider Name (Legal Business Name): ASSURERX CSP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 GODDARD CT
ALPHARETTA GA
30005-2263
US

IV. Provider business mailing address

775 GODDARD CT
ALPHARETTA GA
30005-2263
US

V. Phone/Fax

Practice location:
  • Phone: 770-864-5998
  • Fax:
Mailing address:
  • Phone: 770-864-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DHARMESHKUMAR PATEL
Title or Position: OFFICER IN CHARGE OF LICENSING
Credential:
Phone: 770-864-5998