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General NPI Number Information
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NPI Number | 1306346788
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Entity Type | Organization
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Legal Business Name | COLLABORATIVERX
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 311 GWINNETT DR STE 250
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5671
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Country | US
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Telephone | 404-585-5445
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Fax | 678-498-6093
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Provider Business Mailing Address
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Address Line | 311 GWINNETT DR STE 250 SUITE 250
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5671
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Country | US
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Telephone | 404-585-5445
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Fax | 678-498-6093
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Authorized Official
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Title or Position | PHARMACIST
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Name | NAVEED THARWANI
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Credential |
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Telephone | 404-585-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PHRE010426
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License Number State | GA
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