Organization
NBA PHARMACY LLC
Active
Other names
DAWSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ASHISH PATEL (PHARMACY MANAGER)
(706) 265-7193
Entity
Organization
Contact information
Practice address
66 S 400 CENTER LN, SUITE 125, DAWSONVILLE, GA 30534-6183
(706) 265-3934
(706) 265-8463
Mailing address
310 PASATIEMPO LN, SUWANEE, GA 30024-7621
(404) 234-1800
(706) 265-8463
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010160
GA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168970A
—
GA
01
—
2152987
PK
—
Enumeration date
07/08/2015
Last updated
03/13/2017
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