Provider Demographics
NPI:1497011860
Name:ELLE'S PHARMACY
Entity Type:Organization
Organization Name:ELLE'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:N
Authorized Official - Last Name:GYIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-939-6393
Mailing Address - Street 1:2004 BRISTOL CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 HURRICANE SHOALS RD NW
Practice Address - Street 2:SUITE G
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4115
Practice Address - Country:US
Practice Address - Phone:678-939-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy