Healthcare Provider Details

I. General information

NPI: 1023563194
Provider Name (Legal Business Name): SONDIAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 SCOTT BLVD SUITE 208
DECATUR GA
30033-5605
US

IV. Provider business mailing address

1670 SCOTT BLVD SUITE 208
DECATUR GA
30033-5605
US

V. Phone/Fax

Practice location:
  • Phone: 404-591-0900
  • Fax: 404-591-0909
Mailing address:
  • Phone: 404-591-0900
  • Fax: 404-591-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE010308
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARILYN WATKINS
Title or Position: OWNER
Credential:
Phone: 404-591-0900