Provider Demographics
NPI:1437330487
Name:POLY PLEX PHARMACY INC
Entity Type:Organization
Organization Name:POLY PLEX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-799-3315
Mailing Address - Street 1:2596 DONALD LEE HOLLOWELL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-8300
Mailing Address - Country:US
Mailing Address - Phone:404-799-3315
Mailing Address - Fax:404-799-3375
Practice Address - Street 1:2596 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-8300
Practice Address - Country:US
Practice Address - Phone:404-799-3315
Practice Address - Fax:404-799-3375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLY PLEX PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0893254001OtherBCBS
GA543734369AMedicaid
GA543734369AMedicaid