MIRROR LAKE DRUGS & MEDICAL SERVICES LLC (NPI# 1689272452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689272452 |
| Entity Type | Organization |
| Organization Name | MIRROR LAKE DRUGS & MEDICAL SERVICES LLC |
| Other Organization Name | ROCKMART PHARMACY & MEDICAL SERVICES LLC |
| Practice Address |
895 Dallas Hwy Villa Rica GA 30180-1237 |
| Practice Telephone | 7704621152 |
| Practice Fax Number | 7704621154 |
| Mailing Telephone | 7704621152 |
| Mailing Fax Number | 7704621154 |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2020-10-14 |
| Authorized Official Name | MR. CHYMAR OKORIE IHEKWEREME (PHARMACIST/ CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7704621152 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| ROCKMART PHARMACY & MEDICAL SERVICES LLC | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755256 | Mirror Lake Drugs & Medical Services LLC | Pharmacist | 895 Dallas Hwy, Villa Rica, GA 30180-1237 | 2012-10-24 |
| Street Address |
895 DALLAS HWY |
| City | VILLA RICA |
| State | GA |
| Zip Code | 30180-1237 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755256 | Mirror Lake Drugs & Medical Services LLC | Pharmacist | 895 Dallas Hwy, Villa Rica, GA 30180-1237 | 2012-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174161624 | Crucible Communication Therapy LLC | Speech-Language Pathologist | 9765 Walnut Grove Trail, Villa Rica, GA 30180 | 2019-12-16 |
| 1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
| 1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
| 1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
| 1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
| Find all providers in zip 30180 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1891898649 | Georgia Cvs Pharmacy LLC | Pharmacy | 736 Hwy 78 West, Villa Rica, GA 30180 | 2006-09-07 |
| 1417471087 | Walgreen Co | Pharmacy | 62 Industrial Blvd, Villa Rica, GA 30180-1545 | 2017-07-26 |
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| 1043817208 | Mlk Pharmacy2.0 | Pharmacy | 2457 Mlk Jr Dr Sw Ste A, Atlanta, GA 30311-1712 | 2020-10-01 |
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1205446341 | Sunny Pharmacy | Pharmacy | 5364 Jonesboro Rd, Lake City, GA 30260-3557 | 2020-08-04 |
| 1841818044 | Hospital Authority of Miller County | Pharmacy | 213 Delores Street, Colquitt, GA 39837 | 2020-07-14 |
| Find all providers with the same taxonomy | ||||
| City | VILLA RICA |
| Zip Code | 30180 |
Please comment or provide details below to improve the information on MIRROR LAKE DRUGS & MEDICAL SERVICES LLC.
| 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.