Organization
LAWRENCEVILLE DISCOUNT PHARMACY LLC
Active
Other names
Lawrenceville Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FINGERMAN (OWNER)
(770) 682-9992
Entity
Organization
Contact information
Practice address
905 PARKSIDE WALK LN STE 108, LAWRENCEVILLE, GA 30043-7314
(770) 682-9992
Mailing address
905 PARKSIDE WALK LN, SUITE 108, LAWRENCEVILLE, GA 30043-7314
(770) 682-9992
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009807
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1162089
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/23/2012
Last updated
07/26/2012
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