Healthcare Provider Details

I. General information

NPI: 1932477817
Provider Name (Legal Business Name): ARTEM PHARMACEUTICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 ROSWELL ST NE STE D
MARIETTA GA
30060-2163
US

IV. Provider business mailing address

595 ROSWELL ST NE SUITE D
MARIETTA GA
30060-8218
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-3626
  • Fax: 770-944-3627
Mailing address:
  • Phone: 770-944-3626
  • Fax: 770-944-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHRE009815
License Number StateGA

VIII. Authorized Official

Name: MARTIN WODI
Title or Position: PHARMACIST
Credential:
Phone: 770-944-3626