# PEACHTREE PHARMACY & MEDICAL SUPPLY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peachtree Pharmacy & Medical Supply, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982954095
- **Authorized official:** PAUL EKWEBELEM (PHARMACIST/CCEO)
- **Authorized official phone:** (404) 488-4525

## Contact information

- **Practice address:** 579 CONCORD RD SE STE 900, SMYRNA, GA 30082-2739
- **Practice address phone:** (770) 405-8664
- **Practice address fax:** (770) 405-8663
- **Mailing address:** 579 CONCORD RD SE STE 900, SMYRNA, GA 30082-2739
- **Mailing address phone:** (770) 405-8664
- **Mailing address fax:** (770) 405-8663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE009856 | GA | Yes |

## Other

- **Enumeration date:** 09/17/2012
- **Last updated:** 09/17/2012