Healthcare Provider Details

I. General information

NPI: 1720093354
Provider Name (Legal Business Name): FIRST PHARMACY WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 DOUTHIT FERRY RD
CARTERSVILLE GA
30120-4098
US

IV. Provider business mailing address

75 DOUTHIT FERRY RD
CARTERSVILLE GA
30120-4098
US

V. Phone/Fax

Practice location:
  • Phone: 770-606-9901
  • Fax: 678-605-9885
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009006
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHENDRA PATEL
Title or Position: OWNER
Credential: PHARMD
Phone: 770-606-9901