Provider Demographics
NPI:1790995850
Name:SOCIAL CIRCLE PHARMACY AND SUPPLIES INC.
Entity Type:Organization
Organization Name:SOCIAL CIRCLE PHARMACY AND SUPPLIES INC.
Other - Org Name:SOCIAL CIRCLE PHARMACY AND SUPPLIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IROEMEHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:IKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:177-026-5174
Mailing Address - Street 1:1027 BATEMAN DR # A
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5025
Mailing Address - Country:US
Mailing Address - Phone:770-464-4330
Mailing Address - Fax:770-464-4323
Practice Address - Street 1:1027 BATEMAN DR # A
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5025
Practice Address - Country:US
Practice Address - Phone:770-464-4330
Practice Address - Fax:770-464-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0091523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA109904598AMedicaid