Organization · Type 2 NPI

Mirror Lake Drugs & Medical Services LLC

Community/Retail Pharmacy · Villa Rica, GA

NPI number 1962755256 Active

Practice location

895 Dallas Hwy
Villa Rica, GA 30180-1237

Fax (770) 462-1154

Specialties and licenses

Taxonomy	Code	License
Pharmacist	183500000X	None listed
Pharmacy	333600000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	PHRE009876 (GA)

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 …

Another provider at this address

Mirror Lake Drugs & Medical Services LLCCommunity/Retail Pharmacy Villa Rica, GA NPI 1689272452

Other community/retail pharmacy providers in Villa Rica

See all in Villa Rica →

NPI record

NPI: 1962755256
Entity type: Organization (Type 2)
Issued: Oct 24, 2012
Last updated: Oct 22, 2020
Status: Active

Other names

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Rockmart Pharmacy & Medical Services LLC · former legal business name

Authorized official

Mr. Chymar Okorie Ihekwereme, RPH
Pic/chief Executive Officer
(770) 462-1152

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962755256

Mirror Lake Drugs & Medical Services LLC's National Provider Identifier is 1962755256, issued on Oct 24, 2012. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Villa Rica, GA. The record was last updated on Oct 22, 2020.