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General NPI Number Information
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NPI Number | 1396658951
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Entity Type | Organization
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Legal Business Name | LOWTIDE PHARMACY ATLANTA LLC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 91135 EAST METRO PKWY
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City | OXFORD
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State | GA
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Zip | 30054-4226
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Country | US
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Telephone | 470-682-2068
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Fax | 678-750-1035
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Provider Business Mailing Address
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Address Line | 91135 EAST METRO PKWY
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City | OXFORD
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State | GA
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Zip | 30054-4226
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Country | US
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Telephone | 470-682-2068
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Fax | 678-750-1035
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Authorized Official
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Title or Position | PIC/MANAGING PARTNER
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Name | DR. KELECHUKWU ITEOGU
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Credential | PHARMD
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Telephone | 478-954-2364
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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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Taxonomy #2
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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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