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General NPI Number Information
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NPI Number | 1043817208
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Entity Type | Organization
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Legal Business Name | MLK PHARMACY2.0
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 2457 MLK JR DR SW STE A
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City | ATLANTA
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State | GA
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Zip | 30311-1712
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Country | US
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Telephone | 678-705-5750
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Fax | 404-500-2152
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Provider Business Mailing Address
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Address Line | 2457 MLK JR DR SW STE A
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City | ATLANTA
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State | GA
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Zip | 30311-1712
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Country | US
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Telephone | 678-705-5750
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Fax | 404-500-2152
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Authorized Official
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Title or Position | OWNER
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Name | PRINCE WALKER
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Credential |
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Telephone | 202-384-9370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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