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General NPI Number Information
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NPI Number | 1730321316
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Entity Type | Organization
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Legal Business Name | PHARMADOOR RX LLC
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Dates
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Enumeration Date | 03/29/2009
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Last Update Date | 03/29/2009
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Provider Practice Location Address
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Address Line | 2945 BUFORD HWY NE SUITE P
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City | ATLANTA
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State | GA
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Zip | 30329-1834
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Country | US
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Telephone | 770-322-3420
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Fax | 770-922-9501
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Provider Business Mailing Address
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Address Line | 151 MILAM DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2975
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Country | US
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Telephone | 404-452-4101
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Fax |
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | MRS. LEVETTE FLEMING
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Credential | RPH
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Telephone | 404-452-4101
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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 | 18553
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License Number State | GA
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 008598
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 18553
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License Number State | GA
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