=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841214103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME PHARMACEUTICALS AND COMPOUNDING PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 11/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5505 PEACHTREE DUNWOODY RD NE SUITE G-95
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-250-9656
-----------------------------------------------------
Fax | 404-250-9226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5505 PEACHTREE DUNWOODY RD STE G95
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-250-9656
-----------------------------------------------------
Fax | 404-250-9226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEW OWNER/PIC
-----------------------------------------------------
Name | MRS. AREZOO AKHAVAN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 404-642-1818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------