Peachtree Pharmacy & Medical Supply, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009856 Issued in GA

Legal business name

PEACHTREE PHARMACY & MEDICAL SUPPLY, INC.

Practice address

579 Concord Rd SE Ste 900
Smyrna, GA 30082-2739

Phone

(770) 405-8664

Fax

(770) 405-8663

NPI assigned

Sep 17, 2012

Organization subpart

No

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

Authorized official

Name

Paul Ekwebelem

Title

Pharmacist/Cceo

Phone

(404) 488-4525

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Peachtree Pharmacy & Medical Supply, Inc. Doing business as

Locations

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1982954095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "579 CONCORD RD SE STE 900",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300822739",
            "telephone_number": "770-405-8664",
            "fax_number": "770-405-8663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "579 CONCORD RD SE STE 900",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300822739",
            "telephone_number": "770-405-8664",
            "fax_number": "770-405-8663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE PHARMACY & MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "EKWEBELEM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PHARMACIST/CCEO",
        "authorized_official_telephone_number": "404-488-4525"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1162801",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Pharmacy & Medical Supply, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Smyrna, GA
• Providers in Smyrna, 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 Sep 17, 2012; 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.