Organization
PAVILION COMPOUNDING PHARMACY LLC
Active
Other names
PAVILION COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD CHERSON RPH (OWNER/MANAGER)
(404) 350-5780
Entity
Organization
Contact information
Practice address
3193 HOWELL MILL RD NW, STE 122A, ATLANTA, GA 30327-2119
(404) 350-5780
(404) 350-5640
Mailing address
3193 HOWELL MILL RD NW, STE 122A, ATLANTA, GA 30327-2119
(404) 350-5780
(404) 350-5640
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006901
GA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015906
PK
—
Enumeration date
03/07/2007
Last updated
03/20/2014
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