NPIMap

Organization Active NPI

East Marietta Drug Company, Inc

  • Long Term Care Pharmacy
  • Marietta, GA
National Provider Identifier
1972000917
Registry record updated Apr 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHRE007888 Issued in GA
Legal business name
EAST MARIETTA DRUG COMPANY, INC
Doing business as
East Marietta Drug Company, Inc
Practice address
1480 Roswell Rd
Marietta, GA 30062-3670
Phone
(770) 973-7600
Fax
(770) 973-3032
NPI assigned
Apr 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2018

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

Authorized official

Name
Jonathan Marquess
Title
Owner
Phone
(770) 973-7600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X PHRE007888 GA Primary

Addresses

Primary practice location

1480 Roswell Rd
Marietta, GA 30062-3670

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
000026342AMedicaidGA
2176495OtherPK

Other names 1

  • East Marietta Drug Company, Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Marietta Drug Co Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522972800000",
    "number": "1972000917",
    "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": "1480 ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300623670",
            "telephone_number": "770-973-7600",
            "fax_number": "770-973-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MARIETTA DRUG COMPANY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-06",
        "last_updated": "2018-04-06",
        "status": "A",
        "authorized_official_last_name": "MARQUESS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-973-7600"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE007888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000026342A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176495",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Marietta Drug Company, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; 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.