Basic Information
| Provider Information | |||||||||
| NPI: | 1609523497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACT ATLANTA PHARMACY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 PARKSIDE WALK LN STE 108 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300437314 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 WINN WAY STE 221A | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042923810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | THARWANI | ||||||||
| AuthorizedOfficialFirstName: | NAVEED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7708468671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.