Provider Demographics
NPI:1780448001
Name:MZ VACCINE LLC
Entity type:Organization
Organization Name:MZ VACCINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOWRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-759-9594
Mailing Address - Street 1:6101 NORTHLAKE HEIGHTS CIR NE
Mailing Address - Street 2:AVANA CITYNORTH APARTMENTS
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2258
Mailing Address - Country:US
Mailing Address - Phone:770-572-1971
Mailing Address - Fax:
Practice Address - Street 1:2244 HENDERSON MILL RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2775
Practice Address - Country:US
Practice Address - Phone:888-574-8648
Practice Address - Fax:770-740-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty