Provider Demographics
NPI:1326744558
Name:LAABH PHARMACY LLC
Entity Type:Organization
Organization Name:LAABH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRISHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-785-6470
Mailing Address - Street 1:4369 SUWANEE DAM RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4646
Mailing Address - Country:US
Mailing Address - Phone:470-780-4422
Mailing Address - Fax:470-780-4423
Practice Address - Street 1:4369 SUWANEE DAM RD STE 102
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4646
Practice Address - Country:US
Practice Address - Phone:470-780-4422
Practice Address - Fax:470-780-4423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAABH PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003267941AMedicaid