Provider Demographics
NPI:1437420031
Name:PARKWAY PHARMACY, LLC
Entity Type:Organization
Organization Name:PARKWAY PHARMACY, LLC
Other - Org Name:PARKWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GASS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-855-8475
Mailing Address - Street 1:4700 BATTLEFIELD PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5170
Mailing Address - Country:US
Mailing Address - Phone:706-866-8475
Mailing Address - Fax:706-866-8477
Practice Address - Street 1:4700 BATTLEFIELD PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5170
Practice Address - Country:US
Practice Address - Phone:706-866-8475
Practice Address - Fax:706-866-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0088723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA224562758AMedicaid