Healthcare Provider Details

I. General information

NPI: 1285050823
Provider Name (Legal Business Name): DULUTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 PLEASANT HILL RD STE 103
DULUTH GA
30096-4807
US

IV. Provider business mailing address

3890 PLEASANT HILL RD STE 101B
DULUTH GA
30096-4807
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-2820
  • Fax: 770-476-2811
Mailing address:
  • Phone: 177-047-6282
  • Fax: 770-476-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009996
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BADRINATH JAYANTHI
Title or Position: PHARMACIST
Credential:
Phone: 678-254-9200