Provider Demographics
NPI:1194216697
Name:874 TOTAL PHARMACY LLC
Entity Type:Organization
Organization Name:874 TOTAL PHARMACY LLC
Other - Org Name:TOTAL FOOD & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:678-337-8814
Mailing Address - Street 1:PO BOX 3028
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0052
Mailing Address - Country:US
Mailing Address - Phone:470-355-8584
Mailing Address - Fax:
Practice Address - Street 1:874 RALPH DAVID ABERNATHY BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1829
Practice Address - Country:US
Practice Address - Phone:470-355-8584
Practice Address - Fax:470-355-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0106273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175434OtherPK