=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265199707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAMASTE NEIGHBORHOOD PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2021
-----------------------------------------------------
Last Update Date | 11/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S PROGRESS AVE
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17109-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-936-8350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4236 KINGS TROOP RD
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-936-8350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MANOJ PRADHAN
-----------------------------------------------------
Credential | DR.
-----------------------------------------------------
Telephone | 404-936-8350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------