Lilburn Community Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009917 Issued in GA

Legal business name

LILBURN COMMUNITY PHARMACY

Practice address

4025 Lawrenceville Hwy NW Ste D
Lilburn, GA 30047-2876

Phone

(770) 710-0478

Fax

(770) 710-0861

NPI assigned

Apr 17, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samina C Khatri, PHARMACYNPI 1497346365

Title

Owner/Organizer

Phone

(770) 710-0478

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Lilburn Community Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samina Khatri, RPH

  • Pharmacist
  • Lilburn, GA
  • NPI 1497346365
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714780800000",
    "number": "1134563406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 WHITESTONE CT SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300803116",
            "telephone_number": "404-909-8052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 LAWRENCEVILLE HWY NW STE D",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472876",
            "telephone_number": "770-710-0478",
            "fax_number": "770-710-0861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 Lester Rd NW Ste B",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300444046",
            "country_code": "US",
            "telephone_number": "770-935-1515 x306",
            "fax_number": "770-710-0861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LILBURN COMMUNITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-17",
        "last_updated": "2024-05-04",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "KHATRI",
        "authorized_official_first_name": "SAMINA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/ORGANIZER",
        "authorized_official_telephone_number": "770-710-0478",
        "authorized_official_credential": "PHARMACY"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009917",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2139893",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003133182A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lilburn Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.