Healthcare Provider Details

I. General information

NPI: 1548264039
Provider Name (Legal Business Name): EAST MARIETTA DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 ROSWELL RD
MARIETTA GA
30062-3670
US

IV. Provider business mailing address

1480 ROSWELL RD
MARIETTA GA
30062-3670
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-7600
  • Fax: 770-973-3032
Mailing address:
  • Phone: 770-973-7600
  • Fax: 770-973-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00026342B
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number00026342A
License Number StateGA

VIII. Authorized Official

Name: MRS. PAMELA MARQUESS
Title or Position: SECRETARY
Credential: PHARM D
Phone: 770-973-7600