Provider Demographics
NPI:1255768214
Name:PHAMCARERX LLC
Entity type:Organization
Organization Name:PHAMCARERX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-590-3785
Mailing Address - Street 1:1141 SHERIDAN RD NE
Mailing Address - Street 2:STE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3714
Mailing Address - Country:US
Mailing Address - Phone:404-590-3785
Mailing Address - Fax:678-883-0856
Practice Address - Street 1:1141 SHERIDAN RD NE
Practice Address - Street 2:STE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3714
Practice Address - Country:US
Practice Address - Phone:404-590-3785
Practice Address - Fax:678-883-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty