=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770662082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRUG PARK INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5232 OLD NATIONAL HWY
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-593-2028
-----------------------------------------------------
Fax | 404-593-2030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5232 OLD NATIONAL HWY
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-593-2028
-----------------------------------------------------
Fax | 404-593-2030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MARK ANTHONY UNACHUKWU
-----------------------------------------------------
Credential | B PHARM
-----------------------------------------------------
Telephone | 404-593-2028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------