# EASTLAKE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EASTLAKE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255676326
- **Authorized official:** THOMAS JUSU (OWNER PHARMACIST-IN-CHARGE)
- **Authorized official phone:** (678) 357-1044

## Contact information

- **Practice address:** 1308 GLENWOOD AVE SE, ATLANTA, GA 30316-2077
- **Practice address phone:** (770) 593-8688
- **Mailing address:** 4141 BROOKS MILL DR, LITHONIA, GA 30038-4144
- **Mailing address phone:** (678) 357-1044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE009881 | GA | Yes |

## Other

- **Enumeration date:** 11/30/2012
- **Last updated:** 11/30/2012