Healthcare Provider Details

I. General information

NPI: 1609676733
Provider Name (Legal Business Name): MEDLOCK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11035 MEDLOCK BRIDGE RD STE 40
JOHNS CREEK GA
30097-1981
US

IV. Provider business mailing address

11035 MEDLOCK BRIDGE RD STE 40
JOHNS CREEK GA
30097-1981
US

V. Phone/Fax

Practice location:
  • Phone: 678-691-1375
  • Fax: 800-805-4561
Mailing address:
  • Phone: 678-691-1375
  • Fax: 800-805-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: THERESA USTA
Title or Position: OWNER
Credential:
Phone: 678-691-1375