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General NPI Number Information
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NPI Number | 1003391491
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Entity Type | Organization
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Legal Business Name | PLATINUM PHARMACY LLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 935 LANIER AVE W STE 1008
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7434
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Country | US
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Telephone | 404-902-5811
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Fax | 678-519-3115
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Provider Business Mailing Address
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Address Line | 935 LANIER AVE W STE 1008
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7434
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Country | US
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Telephone | 404-902-5811
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Fax | 678-519-3115
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL OBICHI
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Credential |
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Telephone | 404-822-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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