Organization Active NPI

Mirror Lake Drugs & Medical Services LLC

  • Community/Retail Pharmacy
  • Villa Rica, GA
National Provider Identifier
1689272452
Registry record updated Mar 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MIRROR LAKE DRUGS & MEDICAL SERVICES LLC
Practice address
895 Dallas Hwy
Villa Rica, GA 30180-1237
Phone
(770) 462-1152
Fax
(770) 462-1154
NPI assigned
Oct 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2026

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

Authorized official

Name
Mr. Chymar Okorie Ihekwereme, RPHNPI 1548514631
Title
Pharmacist/ Chief Executive Officer
Phone
(770) 462-1152

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

895 Dallas Hwy
Villa Rica, GA 30180-1237

Mailing address

895 Dallas Hwy
Villa Rica, GA 30180-1237
Phone (770) 462-1152

Other names 2

  • MIRROR LAKE DRUGS Doing business as
  • ROCKMART PHARMACY & MEDICAL SERVICES LLC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774569600000",
    "number": "1689272452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 DALLAS HWY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801237",
            "telephone_number": "770-462-1152",
            "fax_number": "770-462-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 DALLAS HWY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801237",
            "telephone_number": "770-462-1152",
            "fax_number": "770-462-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRROR LAKE DRUGS & MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A",
        "authorized_official_last_name": "IHEKWEREME",
        "authorized_official_first_name": "CHYMAR",
        "authorized_official_middle_name": "OKORIE",
        "authorized_official_title_or_position": "PHARMACIST/ CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "770-462-1152",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIRROR LAKE DRUGS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ROCKMART PHARMACY & MEDICAL SERVICES LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "ROCKMART PHARMACY & MEDICAL SERVICES LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; 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.