Healthcare Provider Details

I. General information

NPI: 1790995850
Provider Name (Legal Business Name): SOCIAL CIRCLE PHARMACY AND SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BATEMAN DR # A
SOCIAL CIRCLE GA
30025-5025
US

IV. Provider business mailing address

1027 BATEMAN DR # A
SOCIAL CIRCLE GA
30025-5025
US

V. Phone/Fax

Practice location:
  • Phone: 770-464-4330
  • Fax: 770-464-4323
Mailing address:
  • Phone: 770-464-4330
  • Fax: 770-464-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009152
License Number StateGA

VIII. Authorized Official

Name: IROEMEHA C IKE
Title or Position: PRESIDENT
Credential: RPH
Phone: 177-026-5174