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NPI Code Detail

MEDICARE: EAST MARIETTA DRUG CO INC

MEDICARE: EAST MARIETTA DRUG CO 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
1332BX2000XOxygen Equipment & Supplies (DME)0831400001GA
2333600000XPharmacy1112072GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31112072OTHERGANABP

General Provider Information

NPI Number : 1396747580
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST MARIETTA DRUG CO INC
Provider Business Mailing Address
First Line : 1480 ROSWELL RD
Second Line :
City : MARIETTA
State : GA
Zip : 30062-3670
Country : US
Telephone Number : 770-973-7600
Fax Number : 770-973-3032
Provider Business Practice Location Address
First Line : 1480 ROSWELL RD
Second Line :
City : MARIETTA
State : GA
Zip : 30062-3670
Country : US
Telephone Number : 770-973-7600
Fax Number : 770-973-3032
Authorized Official
Title or Position : SECRETARY
Name : MRS. PAMALA SMITH MARQUESS
Credential : PHARMD
Telephone Number : 770-973-7600
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/17/2012

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Practice Fax: 770-973-3032
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Practice Location Address:
1480 ROSWELL RD
MARIETTA, GA
30062-3670
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1710320981 — PAMALA SMITH MARQUESS PHARMD
Practice Location Address:
1480 ROSWELL RD
MARIETTA, GA
30062-3670
Practice Phone: 770-973-7600
Practice Fax: 770-973-3032
1972000917 — EAST MARIETTA DRUG COMPANY, INC
Practice Location Address:
1480 ROSWELL RD
MARIETTA, GA
30062-3670
Practice Phone: 770-973-7600
Practice Fax: 770-973-3032

Directions to “EAST MARIETTA DRUG CO INC ” Practice Location

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