Provider Demographics
NPI:1386743995
Name:ROCKY HILL HOLDINGS LLC
Entity type:Organization
Organization Name:ROCKY HILL HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-222-8001
Mailing Address - Street 1:3592 OLD ATLANTA RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6889
Mailing Address - Country:US
Mailing Address - Phone:678-513-7473
Mailing Address - Fax:678-513-7284
Practice Address - Street 1:3592 OLD ATLANTA RD
Practice Address - Street 2:STE 105
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6889
Practice Address - Country:US
Practice Address - Phone:678-513-7473
Practice Address - Fax:678-513-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0089593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA383154225AMedicaid
2150936OtherPK