Provider Demographics
NPI:1942756176
Name:MED-4-YOU LLC
Entity Type:Organization
Organization Name:MED-4-YOU LLC
Other - Org Name:MED-4-YOU LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-587-8099
Mailing Address - Street 1:3970 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE#200
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4809
Mailing Address - Country:US
Mailing Address - Phone:470-299-5292
Mailing Address - Fax:470-395-9140
Practice Address - Street 1:3970 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30096-4809
Practice Address - Country:US
Practice Address - Phone:470-299-5292
Practice Address - Fax:470-395-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
GAPHRE0103063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003182316AMedicaid
2163853OtherPK