Provider Demographics
NPI:1730321316
Name:PHARMADOOR RX LLC
Entity Type:Organization
Organization Name:PHARMADOOR RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-452-4101
Mailing Address - Street 1:151 MILAM DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2975
Mailing Address - Country:US
Mailing Address - Phone:404-452-4101
Mailing Address - Fax:
Practice Address - Street 1:2945 BUFORD HWY NE
Practice Address - Street 2:SUITE P
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1834
Practice Address - Country:US
Practice Address - Phone:770-322-3420
Practice Address - Fax:770-922-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18553333600000X, 3336C0003X
3336C0003X
SC0085983336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy