Healthcare Provider Details

I. General information

NPI: 1336172527
Provider Name (Legal Business Name): SIMS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PL SUITE 101
CARROLLTON GA
30117-3874
US

IV. Provider business mailing address

100 PROFESSIONAL PL SUITE 101
CARROLLTON GA
30117-3874
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-4456
  • Fax: 770-834-4671
Mailing address:
  • Phone: 770-834-4456
  • Fax: 770-834-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008802
License Number StateGA

VIII. Authorized Official

Name: KEITH ALLEN LIPHAM
Title or Position: PRES./RPH
Credential: PHARMD
Phone: 770-258-3366