Organization
MAS PHARMACY AND COMPOUNDING LAB LLC
Active
Other names
MAS PHARMACY AND COMPOUNDING LAB LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VERA MOUMAH (PRESIDENT)
(770) 732-9342
Entity
Organization
Contact information
Practice address
705 S GORDON RD SW, STE A, MABLETON, GA 30126-5138
(770) 732-9342
(770) 732-9347
Mailing address
705 S GORDON RD SW, STE A, MABLETON, GA 30126-5138
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009151
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1156466
OTHER ID NUMBER
—
Enumeration date
10/29/2007
Last updated
04/08/2008
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