Provider Demographics
NPI:1487833919
Name:SANTA FE PHARMACY
Entity Type:Organization
Organization Name:SANTA FE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-495-7942
Mailing Address - Street 1:3750 VENTURE DR
Mailing Address - Street 2:STE 140
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3750 VENTURE DR
Practice Address - Street 2:STE 140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1808
Practice Address - Country:US
Practice Address - Phone:770-495-7942
Practice Address - Fax:770-495-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0094043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1156480OtherOTHER ID NUMBER