Provider Demographics
NPI:1518049279
Name:CIMIRCAU INC DBA WASHINGTON ROAD PHARMACY
Entity Type:Organization
Organization Name:CIMIRCAU INC DBA WASHINGTON ROAD PHARMACY
Other - Org Name:WASHINGTON ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACISTINCHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANIKPE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARM D
Authorized Official - Phone:404-761-6488
Mailing Address - Street 1:3518 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5844
Mailing Address - Country:US
Mailing Address - Phone:404-761-6488
Mailing Address - Fax:404-762-8375
Practice Address - Street 1:3518 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5844
Practice Address - Country:US
Practice Address - Phone:404-761-6488
Practice Address - Fax:404-762-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000415071A332B00000X
GAPHRE0029813336C0003X, 3336C0004X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000415071AMedicaid