Healthcare Provider Details

I. General information

NPI: 1134712763
Provider Name (Legal Business Name): PIEDMONT DIRECT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 BEN BURTON CIR
BOGART GA
30622-1790
US

IV. Provider business mailing address

190 BEN BURTON CIR
BOGART GA
30622-1790
US

V. Phone/Fax

Practice location:
  • Phone: 833-551-2024
  • Fax: 833-439-0010
Mailing address:
  • Phone: 833-551-2024
  • Fax: 833-439-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER STOREY HARBIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 706-660-2877