Organization
OLD NORCROSS ROAD PHARMACY LLC
Active
Other names
Old Norcross Road Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LINUS IGBOKWE (DIRECTOR/ OWNER)
(770) 682-8622
Entity
Organization
Contact information
Practice address
558 OLD NORCROSS RD, SUITE 201, LAWRENCEVILLE, GA 30046-4385
(770) 682-8622
(770) 682-8623
Mailing address
558 OLD NORCROSS RD, SUITE 201, LAWRENCEVILLE, GA 30046-4385
(770) 682-8622
(770) 682-8623
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009621
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159424
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/08/2009
Last updated
08/10/2010
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