Provider Demographics
NPI:1639810203
Name:PHYSICIANS PHARMACY & MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:PHYSICIANS PHARMACY & MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-944-9101
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-944-9101
Mailing Address - Fax:770-944-7702
Practice Address - Street 1:3875 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1103
Practice Address - Country:US
Practice Address - Phone:770-944-9101
Practice Address - Fax:770-944-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy