Provider Demographics
NPI:1285022277
Name:EXPRESS FOOD & PHARMACY INVESTMENT LLC
Entity Type:Organization
Organization Name:EXPRESS FOOD & PHARMACY INVESTMENT LLC
Other - Org Name:EXPRESS FOOD AND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJGURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-755-4232
Mailing Address - Street 1:1067 PEARL MIST DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5496
Mailing Address - Country:US
Mailing Address - Phone:678-933-8965
Mailing Address - Fax:404-818-0077
Practice Address - Street 1:2111 CAMPBELLTON RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-4605
Practice Address - Country:US
Practice Address - Phone:404-755-4232
Practice Address - Fax:404-753-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy