Fayette Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FAYETTE PHARMACY LLC

Practice address

600 Lanier Ave W Ste 203
Fayetteville, GA 30214-1833

Phone

(678) 470-4280

Fax

(678) 302-7484

NPI assigned

Jul 16, 2024

Last updated

Jul 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adewale Bello

Title

Owner

Phone

(404) 302-7788

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1902644917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 LANIER AVE W STE 203",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141833",
            "telephone_number": "678-470-4280",
            "fax_number": "678-302-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 LANIER AVE W STE 203",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141833",
            "telephone_number": "678-470-4280",
            "fax_number": "678-302-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "BELLO",
        "authorized_official_first_name": "ADEWALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-302-7788"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fayette Dental Group PC
• Fayette Emergency Group LLC
• Fayette Eye Center PC
• Fayette Hearing Clinic Inc (Fayette Hearing Clinic)
• Fayette Medical Clinic Optical Shop
• Fayette Plasticsurgery Center LLC
• Fayette Surgical Associates
• Fayette Surgical Associates, LLC
• Fayetteville Center for Nursing & Healing LLC
• Fayetteville Dental Group

• Community/Retail Pharmacy in Fayetteville, GA
• Providers in Fayetteville, 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 Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.