Organization
LEELAND PHARMACY
Active
Other names
MABLETON PHARMACY & UNIFORMS
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN MARQUESS (OWNER)
(770) 948-3133
Entity
Organization
Contact information
Practice address
5390 FLOYD RD SW, MABLETON, GA 30126-2216
(770) 948-3133
(770) 948-3660
Mailing address
8612 MAIN ST, WOODSTOCK, GA 30188-4829
(678) 285-0760
(770) 971-0315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE005933
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000181816A
—
GA
01
—
2176496
PK
—
Enumeration date
04/06/2018
Last updated
04/06/2018
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