Provider Demographics
NPI:1619628591
Name:ATG PHARMACY LLC
Entity Type:Organization
Organization Name:ATG PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-891-9301
Mailing Address - Street 1:4774 LOWER ROSWELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4669
Mailing Address - Country:US
Mailing Address - Phone:404-891-9301
Mailing Address - Fax:404-891-9311
Practice Address - Street 1:4774 LOWER ROSWELL RD STE 104
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4669
Practice Address - Country:US
Practice Address - Phone:404-891-9301
Practice Address - Fax:404-891-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE0190970OtherGEORGIA BOARD OF PHARMACY
GAPHRE0190970OtherGEORGIA BOARD OF PHARMACY