Provider Demographics
NPI:1992861884
Name:DISCOUNT PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:DISCOUNT PHARMACY SERVICES LLC
Other - Org Name:DISCOUNT PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-595-7531
Mailing Address - Street 1:1514 CLEVELAND AVE
Mailing Address - Street 2:STE 114
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6965
Mailing Address - Country:US
Mailing Address - Phone:404-305-8002
Mailing Address - Fax:404-305-8072
Practice Address - Street 1:1514 CLEVELAND AVE
Practice Address - Street 2:STE 114
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6965
Practice Address - Country:US
Practice Address - Phone:404-305-8002
Practice Address - Fax:404-305-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0091093336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0Medicaid
2016464OtherPK