Healthcare Provider Details

I. General information

NPI: 1114556362
Provider Name (Legal Business Name): AMY MARIE SCHLABACH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 HILLANDALE DR
LITHONIA GA
30058-4865
US

IV. Provider business mailing address

5301 ENCHANTED CV SW
LILBURN GA
30047-6331
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027329
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: