Provider Demographics
NPI:1447472626
Name:PEACHTREE PHARMACY SERVICES, L.L.C.
Entity type:Organization
Organization Name:PEACHTREE PHARMACY SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-797-4373
Mailing Address - Street 1:4744 TALL PINES DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3328
Mailing Address - Country:US
Mailing Address - Phone:404-408-0078
Mailing Address - Fax:866-298-0636
Practice Address - Street 1:1018 S MAIN ST
Practice Address - Street 2:HWY 129 SUITE A
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1419
Practice Address - Country:US
Practice Address - Phone:404-408-0078
Practice Address - Fax:866-298-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5932450001Medicare NSC
GA5932450001Medicare Oscar/Certification
GA5932450001Medicare PIN