Provider Demographics
NPI:1740321603
Name:DREAM PHARMACY
Entity type:Organization
Organization Name:DREAM PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOO
Authorized Official - Middle Name:
Authorized Official - Last Name:BYUNG DOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-814-4515
Mailing Address - Street 1:1299 OLD PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2028
Mailing Address - Country:US
Mailing Address - Phone:770-814-4515
Mailing Address - Fax:770-814-4516
Practice Address - Street 1:1299 OLD PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2028
Practice Address - Country:US
Practice Address - Phone:770-814-4515
Practice Address - Fax:770-814-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0091223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136348AMedicaid
2016475OtherPK
GA862074769AMedicaid
GA5866080001Medicare NSC