Organization
KENNESAW RX LLC
Active
Other names
Kennesaw Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RITESH PATEL (PHARMACY MANAGER)
(770) 800-0025
Entity
Organization
Contact information
Practice address
2851 COBB PKWY NW STE 107, KENNESAW, GA 30152-2718
(700) 800-0025
(770) 800-0325
Mailing address
2851 COBB PKWY NW STE 107, KENNESAW, GA 30152-2718
(770) 800-0025
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHRE010626
GA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177779
PK
—
Enumeration date
05/22/2018
Last updated
11/12/2019
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