Provider Demographics
NPI:1215381652
Name:DREAM PHARMACY INC
Entity Type:Organization
Organization Name:DREAM PHARMACY INC
Other - Org Name:YOO PHARMACY DULUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER; CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-299-1971
Mailing Address - Street 1:3610 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4953
Mailing Address - Country:US
Mailing Address - Phone:770-299-1971
Mailing Address - Fax:770-299-1973
Practice Address - Street 1:3610 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 400
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-299-1971
Practice Address - Fax:770-299-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
GAPHRE010279333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159537OtherPK