Provider Demographics
NPI:1821084682
Name:FAITH PHARMACY INC
Entity Type:Organization
Organization Name:FAITH PHARMACY INC
Other - Org Name:FAITH PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MGBELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-641-6025
Mailing Address - Street 1:1720 PHOENIX BLVD, SUITE #400
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5594
Mailing Address - Country:US
Mailing Address - Phone:770-997-1112
Mailing Address - Fax:770-997-1905
Practice Address - Street 1:1720 PHOENIX BLVD, SUITE #400
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5594
Practice Address - Country:US
Practice Address - Phone:770-997-1112
Practice Address - Fax:770-997-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130228OtherPK
GA805224208AMedicaid
GA805224208AMedicaid