Provider Demographics
NPI:1336548304
Name:TRANS ALLIANCE MED AND DRUGS
Entity Type:Organization
Organization Name:TRANS ALLIANCE MED AND DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIBI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWABUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-9940
Mailing Address - Street 1:PO BOX 767757
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-7757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 HOLCOMB BRIDGE RD
Practice Address - Street 2:STE 540
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5333
Practice Address - Country:US
Practice Address - Phone:770-992-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0144251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA542140976AMedicaid