Healthcare Provider Details

I. General information

NPI: 1144921107
Provider Name (Legal Business Name): ELI PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 08/14/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11305 BELL RD STE 107
JOHNS CREEK GA
30097-9503
US

IV. Provider business mailing address

1585 PROSPECT RD
LAWRENCEVILLE GA
30043-2838
US

V. Phone/Fax

Practice location:
  • Phone: 678-835-9997
  • Fax: 678-835-9721
Mailing address:
  • Phone: 224-234-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER J HONG
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 678-835-9997