Gainesville Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GAINESVILLE PHARMACY LLC

Practice address

1079 Jesse Jewell Pkwy SW
Gainesville, GA 30501-6103

Phone

(678) 971-1000

Fax

(678) 971-1031

NPI assigned

Jun 21, 2019

Organization subpart

No

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

Authorized official

Name

Itzelis GodreauNPI 1922358860

Title

Manager

Phone

(912) 332-2794

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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

• Itzelis Del Carmen Godreau, PHARM.D

  • Pharmacist
  • Gainesville, GA
  • NPI 1922358860
  NPD Authorized official
• Summer Forte, PHARMD

  • Pharmacist
  • Gainesville, GA
  • NPI 1871180620
  NPD (past)

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1710548664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3651 PEACHTREE PARKWAY SUITE E#422",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "404-884-4588",
            "fax_number": "678-971-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1079 JESSE JEWELL PKWY SW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305016103",
            "telephone_number": "678-971-1000",
            "fax_number": "678-971-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAINESVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-21",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "GODREAU",
        "authorized_official_first_name": "ITZELIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-332-2794"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gainesville Procedure Center LLC
• Gainesville Radiology Group, PC

• Community/Retail Pharmacy in Gainesville, GA
• Providers in Gainesville, 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 Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.