1922119569 NPI number — MUSICKS PRESCRIPTION CENTER

Table of content: (NPI 1922119569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922119569 NPI number — MUSICKS PRESCRIPTION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUSICKS PRESCRIPTION CENTER
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:
Provider Other Organization Name Type Code:
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:
1922119569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 S COBB DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-435-4404
Provider Business Mailing Address Fax Number:
770-434-4406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 S COBB DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-435-4404
Provider Business Practice Location Address Fax Number:
770-434-4406
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
CHAMBLEE
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
770-435-4404

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  016064 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE004109 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 00032491A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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