Healthcare Provider Details

I. General information

NPI: 1326744558
Provider Name (Legal Business Name): LAABH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4369 SUWANEE DAM RD STE 102
SUWANEE GA
30024-4646
US

IV. Provider business mailing address

4369 SUWANEE DAM RD STE 102
SUWANEE GA
30024-4646
US

V. Phone/Fax

Practice location:
  • Phone: 470-780-4422
  • Fax: 470-780-4423
Mailing address:
  • Phone: 470-780-4422
  • Fax: 470-780-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GRISHMA PATEL
Title or Position: MANAGER
Credential:
Phone: 770-785-6470