Healthcare Provider Details

I. General information

NPI: 1558796433
Provider Name (Legal Business Name): PAUN P RIMTEPATHIP PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 FLOYD RD SW
MABLETON GA
30126-1673
US

IV. Provider business mailing address

5326 WHITEHAVEN PARK LN SE
MABLETON GA
30126-5954
US

V. Phone/Fax

Practice location:
  • Phone: 770-819-5430
  • Fax:
Mailing address:
  • Phone: 678-428-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: