Provider Demographics
NPI:1285932566
Name:CAMP CREEK PHARMACY LLC
Entity type:Organization
Organization Name:CAMP CREEK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-818-8187
Mailing Address - Street 1:PO BOX 5885
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31107-0885
Mailing Address - Country:US
Mailing Address - Phone:404-494-8010
Mailing Address - Fax:404-494-8025
Practice Address - Street 1:3886 PRINCETON LAKES WAY SW STE 180
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5511
Practice Address - Country:US
Practice Address - Phone:404-494-8010
Practice Address - Fax:404-494-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0097353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1161152OtherNCPDP PROVIDER IDENTIFICATION NUMBER