Provider Demographics
NPI:1750497749
Name:PYRAMID DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:PYRAMID DISCOUNT PHARMACY INC
Other - Org Name:PYRAMID DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINNIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNDE UZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-559-0715
Mailing Address - Street 1:1185 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3612
Mailing Address - Country:US
Mailing Address - Phone:404-559-0715
Mailing Address - Fax:404-559-0347
Practice Address - Street 1:1185 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3612
Practice Address - Country:US
Practice Address - Phone:404-559-0715
Practice Address - Fax:404-559-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
GAPHRE0068393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00352393AMedicaid
1132024OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1176520001Medicare NSC