Provider Demographics
NPI:1528525250
Name:REVUE PHARMACY
Entity type:Organization
Organization Name:REVUE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GICHUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-512-0517
Mailing Address - Street 1:869 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8372
Mailing Address - Country:US
Mailing Address - Phone:702-756-7954
Mailing Address - Fax:470-275-4962
Practice Address - Street 1:869 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8372
Practice Address - Country:US
Practice Address - Phone:470-275-6795
Practice Address - Fax:470-275-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010712OtherGEORGIA BOARD OF PHARMACY