Provider Demographics
NPI:1558557421
Name:ASSISTED LIVING PHARMACY INC
Entity Type:Organization
Organization Name:ASSISTED LIVING PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM D / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:DUNAHOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-867-3550
Mailing Address - Street 1:35 W MIDLAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2564
Mailing Address - Country:US
Mailing Address - Phone:770-867-3550
Mailing Address - Fax:770-867-3566
Practice Address - Street 1:35 W MIDLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2564
Practice Address - Country:US
Practice Address - Phone:770-867-3550
Practice Address - Fax:770-867-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
GARPH0168003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6135800001Medicare NSC