Organization
PEMANA ENTERPRISES LLC
Active
Other names
N. Broad Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY PATEL (OWNER)
(404) 754-9551
Entity
Organization
Contact information
Practice address
1421 N BROAD ST NE, ROME, GA 30161-5215
(770) 837-2512
Mailing address
183 RAVENWOOD DR SE, ROME, GA 30161-3543
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146954
PK
—
Enumeration date
07/22/2014
Last updated
07/22/2014
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