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General NPI Number Information
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NPI Number | 1447472626
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Entity Type | Organization
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Legal Business Name | PEACHTREE PHARMACY SERVICES, L.L.C.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1018 S MAIN ST HWY 129 SUITE A
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City | CLEVELAND
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State | GA
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Zip | 30528-1419
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Country | US
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Telephone | 404-408-0078
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Fax | 866-298-0636
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Provider Business Mailing Address
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Address Line | 4744 TALL PINES DR NW
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City | ATLANTA
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State | GA
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Zip | 30327-3328
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Country | US
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Telephone | 404-408-0078
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Fax | 866-298-0636
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CECILIA HARLAN GANDY
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Credential |
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Telephone | 404-797-4373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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