Basic Information
| Provider Information | |||||||||
| NPI: | 1346589983 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMARA PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 269 RIDGECREST CIR | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305254109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067823100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 269 RIDGECREST CIR | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305254109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067823100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2013 | ||||||||
| LastUpdateDate: | 02/01/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST-IN-CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 7067820482 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMARA | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0004X | PHRE009854 | GA | Y | Suppliers | Pharmacy | Compounding Pharmacy |
No ID Information.