Provider Demographics
NPI:1780639518
Name:JOVANS PHARMACY CORP
Entity Type:Organization
Organization Name:JOVANS PHARMACY CORP
Other - Org Name:JOVANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-481-3651
Mailing Address - Street 1:6001 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6001 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1030
Practice Address - Country:US
Practice Address - Phone:770-968-5800
Practice Address - Fax:770-968-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0090283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154361OtherOTHER ID NUMBER