Provider Demographics
NPI:1093574469
Name:ADDHEALTH PHARMACY INC
Entity Type:Organization
Organization Name:ADDHEALTH PHARMACY INC
Other - Org Name:ADDHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NIMOH
Authorized Official - Last Name:GYIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-589-3507
Mailing Address - Street 1:2482 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5201
Mailing Address - Country:US
Mailing Address - Phone:718-483-8144
Mailing Address - Fax:
Practice Address - Street 1:2482 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5201
Practice Address - Country:US
Practice Address - Phone:718-483-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy