MEDICARE: SKYLINE RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1124723101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE RX INC

Provider Business Mailing Address
First Line	:	4300 PLEASANT HILL RD STE F
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-6379
Country	:	US
Telephone Number	:	470-709-0900
Fax Number	:	470-709-0901

Provider Business Practice Location Address
First Line	:	4300 PLEASANT HILL RD STE F
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-6379
Country	:	US
Telephone Number	:	470-709-0900
Fax Number	:	470-709-0901

Authorized Official
Title or Position	:	OWNER
Name	:	NINA LE
Credential	:
Telephone Number	:	470-709-0900

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	04/10/2023

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Directions to “SKYLINE RX INC ” Practice Location

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