Organization
SUGARLOAF PHARMACY INC
Active
Other names
Sugarloaf Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEROP GOURDIKIAN PHARM D (PHARMACY DIRECTOR)
(770) 220-7770
Entity
Organization
Contact information
Practice address
4825 SUGARLOAF PKWY STE BC, LAWRENCEVILLE, GA 30044-8800
(770) 220-7770
(770) 220-7777
Mailing address
4825 SUGARLOAF PKWY, SUITE B, LAWRENCEVILLE, GA 30044-8800
(770) 220-7770
(770) 220-7777
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009781
GA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116217A
—
GA
01
—
1161594
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/30/2011
Last updated
02/08/2012
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