MEDICARE: POOLES PHARMACY INCORPORATED

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
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHRE005435	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	2020409	OTHER		PK

General Provider Information

NPI Number	:	1982798476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOLES PHARMACY INCORPORATED

Provider Business Mailing Address
First Line	:	660 WHITLOCK AVE NW
Second Line	:	STE G-1
City	:	MARIETTA
State	:	GA
Zip	:	30064-3174
Country	:	US
Telephone Number	:	770-514-1414
Fax Number	:	770-514-8300

Provider Business Practice Location Address
First Line	:	660 WHITLOCK AVE NW STE G-1
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3174
Country	:	US
Telephone Number	:	770-514-1414
Fax Number	:	770-514-8300

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	SHARON SHERRER
Credential	:
Telephone Number	:	770-514-1414

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/19/2025

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