Provider Demographics
NPI:1962935098
Name:PCI PHARMACY INC
Entity type:Organization
Organization Name:PCI PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MBA
Authorized Official - Middle Name:UKOHA
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:404-549-8447
Mailing Address - Street 1:3500 N DECATUR RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-6816
Mailing Address - Country:US
Mailing Address - Phone:404-549-8447
Mailing Address - Fax:678-973-0535
Practice Address - Street 1:3500 N DECATUR RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-6817
Practice Address - Country:US
Practice Address - Phone:404-549-8447
Practice Address - Fax:678-973-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0103513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190274AMedicaid
2168763OtherPK