Organization
COMMUNITY ANCILLARY SERVICES, INC.
Active
Other names
Eldercare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEE (SENIOR VICE PRESIDENT)
(478) 783-1515
Entity
Organization
Contact information
Practice address
4769 S MAIN ST, ACWORTH, GA 30101-5339
(770) 974-4277
(770) 974-4208
Mailing address
PO BOX 1038, ACWORTH, GA 30101-8938
(770) 974-4277
(770) 974-4208
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE008075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00811478A
—
GA
01
—
2020178
PK
—
Enumeration date
08/22/2005
Last updated
03/11/2021
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