Provider Demographics
NPI:1720581440
Name:GWINNETT DRUGS LLC
Entity Type:Organization
Organization Name:GWINNETT DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:THARWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-846-8671
Mailing Address - Street 1:905 PARKSIDE WALK LN STE 108
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7314
Mailing Address - Country:US
Mailing Address - Phone:770-995-5911
Mailing Address - Fax:770-995-5308
Practice Address - Street 1:905 PARKSIDE WALK LN STE 108
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7314
Practice Address - Country:US
Practice Address - Phone:770-995-5911
Practice Address - Fax:770-995-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009959333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176395OtherPK