Healthcare Provider Details

I. General information

NPI: 1699847475
Provider Name (Legal Business Name): LANIER PHARMACY ACQUISITION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 THOMPSON BRIDGE RD
GAINESVILLE GA
30506-1518
US

IV. Provider business mailing address

3560 THOMPSON BRIDGE RD
GAINESVILLE GA
30506-1518
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-8861
  • Fax: 770-503-1201
Mailing address:
  • Phone: 770-536-8861
  • Fax: 770-503-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE007887
License Number StateGA

VIII. Authorized Official

Name: STEPHEN ADAMS
Title or Position: PRES/OWNER/RPH/AO
Credential: RPH
Phone: 770-536-8861