Provider Demographics
NPI:1245785120
Name:LAMBERT PHARMACY LLC
Entity Type:Organization
Organization Name:LAMBERT PHARMACY LLC
Other - Org Name:LAMBERT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-416-6288
Mailing Address - Street 1:164 CASTLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2218
Mailing Address - Country:US
Mailing Address - Phone:770-463-4102
Mailing Address - Fax:
Practice Address - Street 1:15 THOMAS GRACE ANNEX LN STE 150
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3653
Practice Address - Country:US
Practice Address - Phone:470-414-7644
Practice Address - Fax:678-423-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
GA0103233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183874AMedicaid
2163781OtherPK