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General NPI Number Information
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NPI Number | 1295294239
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Entity Type | Organization
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Legal Business Name | EDEN PHARMACY LLC
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 1634 JONESBORO RD SE
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City | ATLANTA
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State | GA
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Zip | 30315-5260
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Country | US
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Telephone | 404-941-7644
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Fax | 404-941-7843
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Provider Business Mailing Address
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Address Line | 990 PEACHTREE INDUSTRIAL BLVD UNIT 1644
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City | SUWANEE
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State | GA
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Zip | 30024-5214
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Country | US
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Telephone | 404-941-7644
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Fax | 404-941-7843
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Authorized Official
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Title or Position | PHARMACIST, MEMBER
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Name | AKSHAY PATEL
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Credential |
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Telephone | 404-941-7644
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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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