Provider Demographics
NPI:1649589581
Name:SPECTRUM HEALTHCARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:SPECTRUM HEALTHCARE SOLUTIONS LLC
Other - Org Name:SPECTRUM HEALTHCARE SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JEMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-344-0148
Mailing Address - Street 1:3151 LENORA CHURCH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4818
Mailing Address - Country:US
Mailing Address - Phone:678-344-0148
Mailing Address - Fax:888-559-9575
Practice Address - Street 1:3151 LENORA CHURCH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4818
Practice Address - Country:US
Practice Address - Phone:678-344-0148
Practice Address - Fax:888-559-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1160376OtherNCPDP PROVIDER IDENTIFICATION NUMBER