Healthcare Provider Details

I. General information

NPI: 1649215229
Provider Name (Legal Business Name): WYATT'S RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10671 VETERANS MEMORIAL HWY
LITHIA SPRINGS GA
30122-2062
US

IV. Provider business mailing address

10671 VETERANS MEMORIAL HWY
LITHIA SPRINGS GA
30122-2062
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-8825
  • Fax: 770-948-8848
Mailing address:
  • Phone: 770-948-8825
  • Fax: 770-948-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010408
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SWETA P JOINES
Title or Position: OWNER
Credential: PHARMD
Phone: 706-975-9581