Provider Demographics
NPI:1780953737
Name:DISCOUNT PHARMACY
Entity type:Organization
Organization Name:DISCOUNT PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-755-5904
Mailing Address - Street 1:827 N HAIRSTON RD STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3441
Mailing Address - Country:US
Mailing Address - Phone:770-755-5904
Mailing Address - Fax:770-755-5971
Practice Address - Street 1:827 N HAIRSTON RD STE D
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3441
Practice Address - Country:US
Practice Address - Phone:770-755-5904
Practice Address - Fax:770-755-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0097993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121199AMedicaid
2133268OtherPK