Organization
CPM PHARMACY LLC
Active
Other names
Advanced Rx Pharmacy 034
Organization subpart
No
Provider details
NPI number
Authorized official
KATI GAINOUS (PHARMACY PROGRAM ADMINISTRATOR)
(925) 621-2900
Entity
Organization
Contact information
Practice address
3870 MEDICAL PARK DR, AUSTELL, GA 30106-1110
(678) 564-2233
(678) 401-4245
Mailing address
C/O ADVANCED RX MANAGEMENT, 4683 CHABOT DRIVE, SUITE 200, PLEASANTON, CA 94588
(925) 621-2909
(904) 389-1082
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009976
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149245
PK
—
Enumeration date
12/26/2013
Last updated
06/11/2015
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