Provider Demographics
NPI:1922520220
Name:ANESTHETIC SUPPLY SERVICE, LLC
Entity Type:Organization
Organization Name:ANESTHETIC SUPPLY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-641-6983
Mailing Address - Street 1:8440 HOLCOMB BRIDGE RD STE 560
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1838
Mailing Address - Country:US
Mailing Address - Phone:678-641-6983
Mailing Address - Fax:
Practice Address - Street 1:8440 HOLCOMB BRIDGE RD STE 560
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1838
Practice Address - Country:US
Practice Address - Phone:678-641-6983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty