Provider Demographics
NPI:1346494838
Name:COMFORT PHARMACY INC
Entity Type:Organization
Organization Name:COMFORT PHARMACY INC
Other - Org Name:COMFORT PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOJIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-329-8454
Mailing Address - Street 1:870 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3621
Mailing Address - Country:US
Mailing Address - Phone:770-469-4040
Mailing Address - Fax:770-469-4088
Practice Address - Street 1:870 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3621
Practice Address - Country:US
Practice Address - Phone:770-469-4040
Practice Address - Fax:770-469-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003119712AMedicaid
1158066OtherNCPDP PROVIDER IDENTIFICATION NUMBER