Healthcare Provider Details

I. General information

NPI: 1699441147
Provider Name (Legal Business Name): LAABH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
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: 908-821-7927
  • Fax: 123-456-7890
Mailing address:
  • Phone: 908-821-7927
  • Fax: 123-456-7890

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 Number
License Number State

VIII. Authorized Official

Name: GRISHMA PATEL
Title or Position: OWNER
Credential:
Phone: 470-780-4422