Organization
BAZE PHARMACY LLC
Active
Other names
BAZE Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ATHELIA EZE (OWNER)
(662) 323-5033
Entity
Organization
Contact information
Practice address
1526 E FORREST AVE STE 102, EAST POINT, GA 30344-6979
(404) 761-4448
(404) 761-7905
Mailing address
900 STARK RD, STARKVILLE, MS 39759-3613
(662) 323-5579
(662) 323-5053
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010285
GA
3336L0003X
Long Term Care Pharmacy
PHRE010285
GA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003175529A
—
GA
05
—
003177187A
—
GA
01
—
2158297
PK
—
Enumeration date
04/25/2016
Last updated
03/29/2017
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