Provider Demographics
NPI:1942279278
Name:PHARMACEUTICAL CONCEPTS PC
Entity Type:Organization
Organization Name:PHARMACEUTICAL CONCEPTS PC
Other - Org Name:LULA PHARMACY AND FOOTHILLS GIFT SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:770-869-3616
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:LULA
Mailing Address - State:GA
Mailing Address - Zip Code:30554-0436
Mailing Address - Country:US
Mailing Address - Phone:770-869-3616
Mailing Address - Fax:770-869-9080
Practice Address - Street 1:6102 BANKS ST
Practice Address - Street 2:
Practice Address - City:LULA
Practice Address - State:GA
Practice Address - Zip Code:30554-5114
Practice Address - Country:US
Practice Address - Phone:770-869-3616
Practice Address - Fax:770-869-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0063693336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013842OtherPK
GA000772395AMedicaid
6088880001Medicare NSC