=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508458837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIELLES PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2021
-----------------------------------------------------
Last Update Date | 02/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3545 PEACHTREE INDUSTRIAL BLVD STE 13
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-8063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-220-6244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3545 PEACHTREE INDUSTRIAL BLVD STE 13
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-8063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-220-6244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE/CO-OWNER
-----------------------------------------------------
Name | DR. AFUA ASANTEWAA OSEI-AKOTO
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 646-220-6244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------