NPIMap

Organization Active NPI

JM Cardinal Investments LLC Lawrenceville

Doing business as Concord Pharmacy

  • Community/Retail Pharmacy
  • Lawrenceville, GA
National Provider Identifier
1912921529
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE008760 Issued in GA
Legal business name
JM CARDINAL INVESTMENTS LLC LAWRENCEVILLE
Doing business as
Concord Pharmacy
Practice address
575 Professional Dr Ste 170
Lawrenceville, GA 30046-3335
Phone
(770) 338-0971
Fax
(770) 338-5275
NPI assigned
Jul 27, 2006
Last updated
Apr 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Authorized official

Name
Willie D Smith
Title
Owner
Phone
(678) 463-9598

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE008760 GA Primary

Addresses

Primary practice location

575 Professional Dr Ste 170
Lawrenceville, GA 30046-3335

Mailing address

8612 Main St
Woodstock, GA 30188-4829
Phone (678) 285-0760

Other identifiers 1

IdentifierTypeStateIssuer
00322858JMedicaidGA

Other names 1

  • Concord Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Concord Drugs4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

575 Professional Dr
Ste 170
Lawrenceville, GA 30046
Phone (770) 338-0971

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1912921529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8612 MAIN ST",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884829",
            "telephone_number": "678-285-0760",
            "fax_number": "770-971-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR STE 170",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463335",
            "telephone_number": "770-338-0971",
            "fax_number": "770-338-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JM CARDINAL INVESTMENTS LLC LAWRENCEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-463-9598"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE008760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00322858J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concord Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Concord Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.