Provider Demographics
NPI:1639358609
Name:YASMIN DISCOUNT PHARMACY LLC
Entity Type:Organization
Organization Name:YASMIN DISCOUNT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-963-5668
Mailing Address - Street 1:5231 MEMORIAL DR STE B1
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3153
Mailing Address - Country:US
Mailing Address - Phone:404-963-5668
Mailing Address - Fax:404-963-5639
Practice Address - Street 1:5231 MEMORIAL DR # S-B1
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3153
Practice Address - Country:US
Practice Address - Phone:404-963-5668
Practice Address - Fax:404-963-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0093673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168353OtherPK