Organization
KSYRX LLC
Active
Other names
Mako Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
IBRAHIM SYLLA (PIC)
(770) 696-9146
Entity
Organization
Contact information
Practice address
5050 JIMMY CARTER BLVD STE 350A, NORCROSS, GA 30093-2759
(770) 696-9146
(470) 299-3159
Mailing address
PO BOX 958277, DULUTH, GA 30095-9539
(281) 755-4922
(470) 299-3159
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHHH000060
GA
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143584
PK
—
Enumeration date
12/27/2013
Last updated
12/27/2013
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