Organization
EXPRESS FOOD & PHARMACY LLC
Active
Other names
Express Food & Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN TRIVEDI (PHARMACIST)
(678) 205-7038
Entity
Organization
Contact information
Practice address
50 UPPER ALABAMA ST SW STE 92, ATLANTA, GA 30303-3105
(404) 818-0075
(404) 818-0077
Mailing address
50 UPPER ALABAMA ST SW STE 92, ATLANTA, GA 30303-3105
(404) 818-0075
(404) 818-0077
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009977
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003144768A
—
GA
01
—
2142948
PK
—
Enumeration date
11/12/2013
Last updated
05/06/2014
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