Healthcare Provider Details

I. General information

NPI: 1255768214
Provider Name (Legal Business Name): PHAMCARERX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 FELLOWSHIP RD
TUCKER GA
30084-4609
US

IV. Provider business mailing address

1141 SHERIDAN RD NE STE A
ATLANTA GA
30324-3714
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-3785
  • Fax: 678-883-0856
Mailing address:
  • Phone: 404-590-3785
  • Fax: 678-883-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE009965
License Number StateGA

VIII. Authorized Official

Name: MR. THY PHAM
Title or Position: PARTNER/CEO
Credential: PHARM.D
Phone: 404-590-3785