Provider Demographics
NPI:1134712763
Name:PIEDMONT DIRECT PHARMACY LLC
Entity type:Organization
Organization Name:PIEDMONT DIRECT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OUTPATIENT PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:IV
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-475-5563
Mailing Address - Street 1:1510 PRINCE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6006
Mailing Address - Country:US
Mailing Address - Phone:706-475-5563
Mailing Address - Fax:
Practice Address - Street 1:1510 PRINCE AVE STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6006
Practice Address - Country:US
Practice Address - Phone:833-551-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy