1861807083 NPI number — PHYSICIANS RX PHARMACY OF ATLANTA

Table of content: (NPI 1861807083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861807083 NPI number — PHYSICIANS RX PHARMACY OF ATLANTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS RX PHARMACY OF ATLANTA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIANS RX PHARMACY OF ATLANTA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861807083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O DOMINIC CUTULI
Provider Second Line Business Mailing Address:
436 SEVENTH AVENUE
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-391-2920
Provider Business Mailing Address Fax Number:
412-391-4703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 PEACHTREE ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-870-7748
Provider Business Practice Location Address Fax Number:
404-529-4537
Provider Enumeration Date:
06/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-789-9288

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE010070 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003153638A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2146664 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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