Provider Demographics
NPI:1508212382
Name:PRESTIGE PHARMACY JOHNS CREEK, LLC
Entity Type:Organization
Organization Name:PRESTIGE PHARMACY JOHNS CREEK, LLC
Other - Org Name:PRESTIGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:678-315-1516
Mailing Address - Street 1:6375 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6375 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3617
Practice Address - Country:US
Practice Address - Phone:678-869-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy