Healthcare Provider Details

I. General information

NPI: 1962935098
Provider Name (Legal Business Name): PCI PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N DECATUR RD STE 108
SCOTTDALE GA
30079-6817
US

IV. Provider business mailing address

3500 N DECATUR RD SUITE 108
SCOTTDALE GA
30079-6816
US

V. Phone/Fax

Practice location:
  • Phone: 404-549-8447
  • Fax: 678-973-0535
Mailing address:
  • Phone: 404-549-8447
  • Fax: 678-973-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010351
License Number StateGA

VIII. Authorized Official

Name: MBA UKOHA KALU
Title or Position: CEO
Credential: PHARMACIST
Phone: 404-549-8447