Provider Demographics
NPI:1992481618
Name:SUWANEE PHARMACY LLC
Entity type:Organization
Organization Name:SUWANEE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-878-2082
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0435
Mailing Address - Country:US
Mailing Address - Phone:678-878-2082
Mailing Address - Fax:678-878-2083
Practice Address - Street 1:2027 LAWRENCEVILLE SUWANEE RD STE 700
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2658
Practice Address - Country:US
Practice Address - Phone:678-878-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy