Mirror Lake Drugs & Medical Services LLC
NPI #1962755256 in Villa Rica, Georgia
Provider Information
- NPI Number
- 1962755256
- Entity Type
- Organization
- Organization Name
- Mirror Lake Drugs & Medical Services LLC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Oct 24, 2012
- Last Updated
- Oct 22, 2020
Practice Location
- Address
- 895 DALLAS HWY
- City
- Villa Rica
- State
- Georgia
- ZIP Code
- 30180-1237
- Phone
- (770) 462-1152
Authorized Official
- Name
- MR. CHYMAR OKORIE IHEKWEREME, RPH
- Title
- PIC/CHIEF EXECUTIVE OFFICER
- Phone
- (770) 462-1152
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacist |
| Pharmacy |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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