Healthcare Provider Details

I. General information

NPI: 1093211005
Provider Name (Legal Business Name): CTCA RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

610 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

V. Phone/Fax

Practice location:
  • Phone: 678-552-2013
  • Fax:
Mailing address:
  • Phone: 678-552-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010615
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS LEHMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-552-2013