Provider Demographics
NPI:1720012537
Name:MANAGED HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:MANAGED HEALTH SOLUTIONS LLC
Other - Org Name:MANAGED HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:678-463-9598
Mailing Address - Street 1:8612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4829
Mailing Address - Country:US
Mailing Address - Phone:770-496-5314
Mailing Address - Fax:770-496-7445
Practice Address - Street 1:3070 BUSINESS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1428
Practice Address - Country:US
Practice Address - Phone:770-496-5314
Practice Address - Fax:770-496-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0100823336L0003X
333600000X
GA0056373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149258OtherPK
FLU346Medicare PIN
P00003265Medicare PIN
0302060203Medicare NSC