Provider Demographics
NPI:1568860088
Name:SANDY SPRINGS MEDICAL CENER PHARMACY
Entity Type:Organization
Organization Name:SANDY SPRINGS MEDICAL CENER PHARMACY
Other - Org Name:E-Z MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-781-1800
Mailing Address - Street 1:199 HILDERBRAND DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3855
Mailing Address - Country:US
Mailing Address - Phone:404-781-1800
Mailing Address - Fax:404-781-1807
Practice Address - Street 1:199 HILDERBRAND DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3855
Practice Address - Country:US
Practice Address - Phone:404-781-1800
Practice Address - Fax:404-781-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy