Provider Demographics
NPI:1639463847
Name:ATLANTA PHARMACY GROUP INC
Entity Type:Organization
Organization Name:ATLANTA PHARMACY GROUP INC
Other - Org Name:WENDER & ROBERTS DRUGS - WPF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-7693
Mailing Address - Street 1:106 ROCK QUARRY RD STE B
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3766
Mailing Address - Country:US
Mailing Address - Phone:770-474-7693
Mailing Address - Fax:770-692-8244
Practice Address - Street 1:1262 W PACES FERRY RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2306
Practice Address - Country:US
Practice Address - Phone:404-237-7551
Practice Address - Fax:404-233-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009749333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130562OtherPK
GA000565397BMedicaid