Provider Demographics
NPI:1245709799
Name:POSITIVE IMPACT HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:POSITIVE IMPACT HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIKLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:470-361-2701
Mailing Address - Street 1:3350 BRECKINRIDGE BLVD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:470-361-2701
Mailing Address - Fax:470-361-2710
Practice Address - Street 1:3350 BRECKINRIDGE BLVD
Practice Address - Street 2:SUITE 200A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:470-361-2701
Practice Address - Fax:470-361-2710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE IMPACT HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-14
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy