EASTLAKE PHARMACY INC


Address: 1308 Glenwood Ave Se, Atlanta, GA 30316-2077
Phone: 7705938688

EASTLAKE PHARMACY INC (NPI# 1255676326) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1255676326
Entity Type Organization
Organization Name EASTLAKE PHARMACY INC
Other Organization Name EASTLAKE PHARMACY
Practice Address 1308 Glenwood Ave Se
Atlanta
GA 30316-2077
Mailing Address 4141 Brooks Mill Dr
Lithonia
GA 30038-4144
Practice Telephone 7705938688
Mailing Telephone 6783571044
Enumeration Date 2012-11-30
Last Update Date 2012-11-30
Authorized Official Name THOMAS JUSU (OWNER PHARMACIST-IN-CHARGE)
Authorized Official Telephone 6783571044
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 3336C0003X Pharmacy
Specialization: Community/Retail Pharmacy
PHRE009881 GA Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
NCPDP PROVIDER IDENTIFICATION NUMBER 1163029 01

Other Provider/Organization Names

Other Name Type Code
EASTLAKE PHARMACY Doing Business As Name - Organization

Office Location

Street Address 1308 GLENWOOD AVE SE
City ATLANTA
State GA
Zip Code 30316-2077

Providers in the same location

NPI Name Taxonomy Address Enumeration
1912475559 Thomas Sao Jusu Pharmacist 1308 Glenwood Ave Se, Atlanta, GA 30316-2077 2018-11-12

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1073156923 Rakiya Williams Counselor 1030 Fayetteville Rd., Atlanta, GA 30316 2019-10-23
1215585815 Madison Victoria Baugh Counselor Chris180, 1030 Fayetteville Rd, Atlanta, GA 30316 2019-08-28
1265089460 Josee Dominque Muldrew Counselor 1030 Fayetteville Rd. Se, Atlanta, GA 30316 2019-08-22
1255984241 Monique Overstreet Counselor 1030 Fayetteville Road, Atlanta, GA 30316 2019-07-19
1023573979 Publix Super Markets, Inc. Durable Medical Equipment & Medical Supplies 905 Memorial Drive Se, Atlanta-fulton, GA 30316 2019-02-05
1740726454 Jimmy Brian Sambula Behavior Technician 1017 Fayetteville Rd. Se, Atlanta, GA 30316 2017-01-19
1033665039 Liberty Group Senior Services Clinic/Center 1879 Glenwood Avenue, Atlanta, GA 30316 2016-08-30
1043673650 The Kroger Co Durable Medical Equipment & Medical Supplies 800 Glenwood Ave Se, Atlanta, GA 30316 2016-03-31
1992143382 Ayodele Osasona Surgery 2004 Oak Terrace Dr Se, Atlanta, GA 30316 2013-06-07
1891945721 Denise Renee Cagle Social Worker 1471 Town Country Dr Se, Atlanta, GA 30316 2008-09-28
Find all providers in zip 30316

Taxonomy Information

Taxonomy Code 3336C0003X
Grouping Suppliers
Classification Pharmacy
Specialization Community/Retail Pharmacy

Taxonomy Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1043817208 Mlk Pharmacy2.0 Pharmacy 2457 Mlk Jr Dr Sw Ste A, Atlanta, GA 30311-1712 2020-10-01
1407492119 Capsule Atlanta LLC Pharmacy 867 Peachtree St Ne Ste 102, Atlanta, GA 30308-1380 2019-11-18
1861978793 Uhs of Peachford Lp Pharmacy 2150 Peachford Rd Ste D, Atlanta, GA 30338 2018-07-13
1497262778 Champions Pharmacy Pharmacy 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 2018-01-08
1912357641 Headland Pharmacy LLC Pharmacy 2973 Headland Drive, Suite B, Atlanta, GA 30331 2016-06-14
1285022277 Express Food & Pharmacy Investment LLC Pharmacy 2111 Campbellton Rd Sw, Atlanta, GA 30311-4605 2014-12-30
1881024479 Camp Creek Village Pharmacy Inc. Pharmacy 3220 Butner Rd Sw Suite #130, Atlanta, GA 30331 2013-11-18
1487093662 Pharm Holdings Pharmacy 102 E Allday St, Atlanta, TX 75551-2305 2013-06-20
1689918468 Wal-mart Stores East Lp Pharmacy 835 Martin Luther King Jr Dr Nw, Atlanta, GA 30314-3644 2012-11-19
1225388572 Chamblee Pharmacy Corporation Pharmacy 3652 Chamblee Dunwoody Rd Ste 3, Atlanta, GA 30341-2120 2012-09-13
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Competitor

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City ATLANTA
Zip Code 30316

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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