Healthcare Provider Details

I. General information

NPI: 1346385333
Provider Name (Legal Business Name): PRUITTHEALTH PHARMACY SERVICES - ATLANTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 JEURGENS CT SUITE A
NORCROSS GA
30093-2219
US

IV. Provider business mailing address

1626 JEURGENS CT SUITE A
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 678-533-6459
  • Fax: 770-931-5253
Mailing address:
  • Phone: 678-533-6459
  • Fax: 770-931-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NEIL L. PRUITT JR.
Title or Position: CHAIRMAN AND CEO
Credential:
Phone: 770-279-6200