Provider Demographics
NPI:1982798476
Name:POOLES PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:POOLES PHARMACY INCORPORATED
Other - Org Name:POOLES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-514-1414
Mailing Address - Street 1:660 WHITLOCK AVE NW
Mailing Address - Street 2:STE G-1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3174
Mailing Address - Country:US
Mailing Address - Phone:770-514-1414
Mailing Address - Fax:770-514-8300
Practice Address - Street 1:660 WHITLOCK AVE NW STE G-1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3174
Practice Address - Country:US
Practice Address - Phone:770-514-1414
Practice Address - Fax:770-514-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
GAPHRE0054353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00860758AMedicaid
2020409OtherPK
4434480001Medicare NSC