# GAINESVILLE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710548664
- **Authorized official:** ITZELIS GODREAU (MANAGER)
- **Authorized official phone:** (912) 332-2794

## Contact information

- **Practice address:** 1079 JESSE JEWELL PKWY SW, GAINESVILLE, GA 30501-6103
- **Practice address phone:** (678) 971-1000
- **Practice address fax:** (678) 971-1031
- **Mailing address:** 3651 PEACHTREE PARKWAY SUITE E\#422, SUWANEE, GA 30024
- **Mailing address phone:** (404) 884-4588
- **Mailing address fax:** (678) 971-1031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/21/2019
- **Last updated:** 03/25/2020