MEDICARE: PHYSICIANS PHARMACY ALLIANCE , 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	333600000X	Pharmacy	PHRE009833	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2135213	OTHER		PK

General Provider Information

NPI Number	:	1487914065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS PHARMACY ALLIANCE , INC

Provider Business Mailing Address
First Line	:	4345 INTERNATIONAL PKWY
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30354-3911
Country	:	US
Telephone Number	:	404-633-6656
Fax Number	:	404-634-6657

Provider Business Practice Location Address
First Line	:	4345 INTERNATIONAL PKWY
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30354-3911
Country	:	US
Telephone Number	:	404-633-6656
Fax Number	:	404-634-6657

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	DEANNA MCFADDEN
Credential	:
Telephone Number	:	866-463-5550

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	06/18/2013

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