Provider Demographics
NPI:1841214103
Name:PRIME PHARMACEUTICALS AND COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:PRIME PHARMACEUTICALS AND COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEW OWNER/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:AREZOO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:404-642-1818
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD STE G95
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1758
Mailing Address - Country:US
Mailing Address - Phone:404-250-9656
Mailing Address - Fax:404-250-9226
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE G-95
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-250-9656
Practice Address - Fax:404-250-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00322858-BMedicaid