Healthcare Provider Details

I. General information

NPI: 1699692244
Provider Name (Legal Business Name): APOTHECARY RX WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3886 PRINCETON LAKES WAY SW STE 120
ATLANTA GA
30331-5511
US

IV. Provider business mailing address

93 ETHAN MOOR
JONESBORO GA
30238-5896
US

V. Phone/Fax

Practice location:
  • Phone: 213-922-0454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE WARREN
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 213-922-0454