Provider Demographics
NPI:1225388572
Name:CHAMBLEE PHARMACY CORPORATION
Entity Type:Organization
Organization Name:CHAMBLEE PHARMACY CORPORATION
Other - Org Name:CHAMBLEE PHARMACY CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-565-6447
Mailing Address - Street 1:3652 CHAMBLEE DUNWOODY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2120
Mailing Address - Country:US
Mailing Address - Phone:678-395-7754
Mailing Address - Fax:678-620-3329
Practice Address - Street 1:3652 CHAMBLEE DUNWOODY RD STE 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-2120
Practice Address - Country:US
Practice Address - Phone:678-395-7754
Practice Address - Fax:678-620-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0098423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1162875OtherNCPDP PROVIDER IDENTIFICATION NUMBER