Healthcare Provider Details

I. General information

NPI: 1902715923
Provider Name (Legal Business Name): DIVYO HEALTH SOLUTIONS, INC. - STORE #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 OLD ELLIS ROAD SUITE 100
ROSWELL GA
30076
US

IV. Provider business mailing address

1100 OLD ELLIS ROAD SUITE 100
ROSWELL GA
30076
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-5200
  • Fax:
Mailing address:
  • Phone: 855-675-5200
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: TONY RAYFUS
Title or Position: OFFICER
Credential:
Phone: 855-675-5200