Healthcare Provider Details

I. General information

NPI: 1609523497
Provider Name (Legal Business Name): PACT ATLANTA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WINN WAY STE 221A
DECATUR GA
30030-1723
US

IV. Provider business mailing address

905 PARKSIDE WALK LN STE 108
LAWRENCEVILLE GA
30043-7314
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-3810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: NAVEED THARWANI
Title or Position: PRESIDENT
Credential:
Phone: 770-846-8671