# MIRROR LAKE DRUGS & MEDICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MIRROR LAKE DRUGS, ROCKMART PHARMACY & MEDICAL SERVICES LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689272452
- **Authorized official:** MR. CHYMAR OKORIE IHEKWEREME RPH (PHARMACIST/ CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (770) 462-1152

## Contact information

- **Practice address:** 895 DALLAS HWY, VILLA RICA, GA 30180-1237
- **Practice address phone:** (770) 462-1152
- **Practice address fax:** (770) 462-1154
- **Mailing address:** 895 DALLAS HWY, VILLA RICA, GA 30180-1237
- **Mailing address phone:** (770) 462-1152
- **Mailing address fax:** (770) 462-1154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/14/2020
- **Last updated:** 03/27/2026