Provider Demographics
NPI:1265737662
Name:A & E PHARMACY INC
Entity type:Organization
Organization Name:A & E PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLISEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPAILLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-301-5445
Mailing Address - Street 1:3853 LAWRENCEVILLE HWY
Mailing Address - Street 2:STE C
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3853 LAWRENCEVILLE HWY
Practice Address - Street 2:STE C
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4521
Practice Address - Country:US
Practice Address - Phone:786-301-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy