Provider Demographics
NPI:1033844220
Name:UNIVERSAL COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:UNIVERSAL COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULKADIR
Authorized Official - Middle Name:HARIR
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-438-6129
Mailing Address - Street 1:4758 MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1448
Mailing Address - Country:US
Mailing Address - Phone:404-963-2279
Mailing Address - Fax:404-963-2298
Practice Address - Street 1:4758 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1448
Practice Address - Country:US
Practice Address - Phone:404-963-2279
Practice Address - Fax:404-963-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy