Provider Demographics
NPI:1891209615
Name:FAMILY WELLNESS PHARMACY LLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS PHARMACY LLC
Other - Org Name:SAIGON PHARMACARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-765-8476
Mailing Address - Street 1:3118 PRESTWYCK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4303
Mailing Address - Country:US
Mailing Address - Phone:678-765-8476
Mailing Address - Fax:678-765-8479
Practice Address - Street 1:1630 PLEASANT HILL RD # C4
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5899
Practice Address - Country:US
Practice Address - Phone:678-765-8476
Practice Address - Fax:678-765-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X, 3336S0011X
GAPHRE0104143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003199366AMedicaid
GA003258370AMedicaid
2174455OtherPK