Provider Demographics
NPI:1225375603
Name:ZAK PHARMACY LLC.
Entity Type:Organization
Organization Name:ZAK PHARMACY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHENAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIYE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-556-0670
Mailing Address - Street 1:4600 E PONCE DE LEON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1839
Mailing Address - Country:US
Mailing Address - Phone:404-500-1451
Mailing Address - Fax:678-974-5383
Practice Address - Street 1:4600 E PONCE DE LEON AVE STE E
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1839
Practice Address - Country:US
Practice Address - Phone:404-500-1451
Practice Address - Fax:678-974-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy