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General NPI Number Information
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NPI Number | 1285050823
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Entity Type | Organization
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Legal Business Name | DULUTH PHARMACY LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 3890 PLEASANT HILL RD STE 103
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City | DULUTH
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State | GA
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Zip | 30096-4807
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Country | US
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Telephone | 770-476-2820
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Fax | 770-476-2811
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Provider Business Mailing Address
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Address Line | 3890 PLEASANT HILL RD STE 101B
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City | DULUTH
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State | GA
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Zip | 30096-4807
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Country | US
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Telephone | 177-047-6282
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Fax | 770-476-2811
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. BADRINATH JAYANTHI
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Credential |
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Telephone | 678-254-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009996
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License Number State | GA
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