Provider Demographics
NPI:1902879265
Name:PHYSICIANS PHARMACY & MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:PHYSICIANS PHARMACY & MEDICAL SUPPLY LLC
Other - Org Name:PHYSICIANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:678-463-9598
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-944-9101
Mailing Address - Fax:770-944-7702
Practice Address - Street 1:3875 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1103
Practice Address - Country:US
Practice Address - Phone:770-944-9101
Practice Address - Fax:770-944-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006#5066332B00000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0376450001Medicare NSC