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General NPI Number Information
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NPI Number | 1265737662
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Entity Type | Organization
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Legal Business Name | A & E PHARMACY INC
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 3853 LAWRENCEVILLE HWY STE C
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City | TUCKER
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State | GA
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Zip | 30084-4521
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Country | US
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Telephone | 786-301-5445
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Fax |
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Provider Business Mailing Address
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Address Line | 3853 LAWRENCEVILLE HWY STE C
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City | TUCKER
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State | GA
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Zip | 30084-4521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLISEO ESPAILLAT
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Credential |
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Telephone | 786-301-5445
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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 | GA
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