Healthcare Provider Details

I. General information

NPI: 1720581440
Provider Name (Legal Business Name): GWINNETT DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 770-995-5911
  • Fax: 770-995-5308
Mailing address:
  • Phone: 770-995-5911
  • Fax: 770-995-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE009959
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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