Provider Demographics
NPI:1770041956
Name:HOLCOMB BRIDGE WELLNESS PHARMACY INC
Entity type:Organization
Organization Name:HOLCOMB BRIDGE WELLNESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR ANSELM
Authorized Official - Middle Name:KWAKU
Authorized Official - Last Name:ADDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMAD
Authorized Official - Phone:678-622-1032
Mailing Address - Street 1:861 HOLCOMB BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1900
Mailing Address - Country:US
Mailing Address - Phone:678-622-1032
Mailing Address - Fax:
Practice Address - Street 1:861 HOLCOMB BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1900
Practice Address - Country:US
Practice Address - Phone:470-297-5749
Practice Address - Fax:470-297-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003229122AMedicaid