Provider Demographics
NPI:1043817208
Name:MLK PHARMACY2.0
Entity Type:Organization
Organization Name:MLK PHARMACY2.0
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-384-9370
Mailing Address - Street 1:2457 MLK JR DR SW STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1712
Mailing Address - Country:US
Mailing Address - Phone:678-705-5750
Mailing Address - Fax:404-500-2152
Practice Address - Street 1:2457 MLK JR DR SW STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1712
Practice Address - Country:US
Practice Address - Phone:678-705-5750
Practice Address - Fax:404-500-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy