Healthcare Provider Details

I. General information

NPI: 1700703121
Provider Name (Legal Business Name): OUTREACH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 PLEASANT HILL RD UNIT A
MARIETTA GA
30068
US

IV. Provider business mailing address

2941 PHILLIPS CT
MARIETTA GA
30068-3161
US

V. Phone/Fax

Practice location:
  • Phone: 678-951-8231
  • Fax:
Mailing address:
  • Phone: 682-551-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA NGUYEN
Title or Position: ORGANIZER
Credential:
Phone: 682-551-6702