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General NPI Number Information
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NPI Number | 1952638579
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Entity Type | Organization
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Legal Business Name | PRUITTHEALTH PHARMACY SERVICES - NORCROSS, INC.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1626 JEURGENS CT BLDG 100 STE B
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone | 770-279-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 JEURGENS CT
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City | NORCROSS
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State | GA
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Zip | 30093-2219
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Country | US
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Telephone | 770-279-6200
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN & CEO OF MGR
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Name | NEIL L. PRUITT JR.
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Credential |
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Telephone | 770-279-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE009656
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | PHRE009656
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE009656
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License Number State | GA
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