Provider Demographics
NPI:1356835821
Name:ROSWELLRX PHARMACY LLC
Entity Type:Organization
Organization Name:ROSWELLRX PHARMACY LLC
Other - Org Name:ROSWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMAN
Authorized Official - Middle Name:SHARMA
Authorized Official - Last Name:BARAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-629-3122
Mailing Address - Street 1:11105 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2403
Mailing Address - Country:US
Mailing Address - Phone:678-629-3122
Mailing Address - Fax:678-629-3347
Practice Address - Street 1:11105 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2403
Practice Address - Country:US
Practice Address - Phone:678-629-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy