# MIRROR LAKE DRUGS & MEDICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rockmart Pharmacy & Medical Services LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962755256
- **Authorized official:** MR. CHYMAR OKORIE IHEKWEREME RPH (PIC/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 |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | — | NULL | — |
| 183500000X | Pharmacist | — | — | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009876 | GA | Yes |

## Other

- **Enumeration date:** 10/24/2012
- **Last updated:** 10/22/2020