Healthcare Provider Details

I. General information

NPI: 1992559629
Provider Name (Legal Business Name): WEST COBB SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 PEACHTREE ST NE STE 100
ATLANTA GA
30309-7901
US

IV. Provider business mailing address

933 PEACHTREE ST NE STE 100
ATLANTA GA
30309-7901
US

V. Phone/Fax

Practice location:
  • Phone: 770-485-0575
  • Fax: 877-411-0199
Mailing address:
  • Phone: 770-485-0575
  • Fax: 877-411-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JITENDRA CHAUDHARI
Title or Position: PHARMACIST
Credential:
Phone: 770-485-0575