Pavilion Compounding Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE006901 Issued in GA

Legal business name

PAVILION COMPOUNDING PHARMACY LLC

Practice address

3193 Howell Mill Rd NW
Ste 122a
Atlanta, GA 30327-2119

Phone

(404) 350-5780

Fax

(404) 350-5640

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Brad Cherson, RPH

Title

Owner/Manager

Phone

(404) 350-5780

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• PAVILION COMPOUNDING PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1801926878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3193 HOWELL MILL RD NW",
            "address_2": "STE 122A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272119",
            "telephone_number": "404-350-5780",
            "fax_number": "404-350-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3193 HOWELL MILL RD NW",
            "address_2": "STE 122A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272119",
            "telephone_number": "404-350-5780",
            "fax_number": "404-350-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "CHERSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "404-350-5780",
        "authorized_official_credential": "RPH"
    },
    "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": "PHRE006901",
            "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": "2015906",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAVILION COMPOUNDING PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Molly Laderer Paulson, RD, LD
• Shelby Paulson
• Diana Marie Paulus, CRNA
• Melinda Pauly, MD
• Tonya R Pauly, MD
• Pavilion Spine Surgery Center LLC
• Patricia P. Pavlik, PAAA
• Alexis Pavlov, PHD, BCBA-D
• Stephany Pavlov
• Nancy Pavuk, NP

• Community/Retail Pharmacy in Atlanta, GA
• Providers in Atlanta, 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 20, 2014; 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.