=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861807083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS RX PHARMACY OF ATLANTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2014
-----------------------------------------------------
Last Update Date | 11/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1605 PEACHTREE ST NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-870-7748
-----------------------------------------------------
Fax | 404-529-4537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | C/O DOMINIC CUTULI 436 SEVENTH AVENUE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-391-2920
-----------------------------------------------------
Fax | 412-391-4703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DONALD SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-789-9288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010070
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------