Provider Demographics
NPI:1972146967
Name:ATLANTIC AVENUE PHARMACEUTICAL, INC
Entity type:Organization
Organization Name:ATLANTIC AVENUE PHARMACEUTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-987-5070
Mailing Address - Street 1:5621 ATLANTIC AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7581
Mailing Address - Country:US
Mailing Address - Phone:919-891-9555
Mailing Address - Fax:919-999-2832
Practice Address - Street 1:5621 ATLANTIC AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-891-9555
Practice Address - Fax:919-999-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy