Healthcare Provider Details

I. General information

NPI: 1679658124
Provider Name (Legal Business Name): BRIARCLIFF PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 CLAIRMONT RD NE
ATLANTA GA
30329-2760
US

IV. Provider business mailing address

2724 CLAIRMONT RD NE
ATLANTA GA
30329-2760
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-0092
  • Fax: 404-633-8905
Mailing address:
  • Phone: 404-728-0092
  • Fax: 404-633-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008616
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAM MARQUESS
Title or Position: COO, MGR
Credential:
Phone: 678-463-9598