Provider Demographics
NPI:1770662082
Name:DRUG PARK INC.
Entity Type:Organization
Organization Name:DRUG PARK INC.
Other - Org Name:DRUG PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:UNACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:B PHARM
Authorized Official - Phone:404-593-2028
Mailing Address - Street 1:5232 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3202
Mailing Address - Country:US
Mailing Address - Phone:404-593-2028
Mailing Address - Fax:404-593-2030
Practice Address - Street 1:5232 OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3202
Practice Address - Country:US
Practice Address - Phone:404-593-2028
Practice Address - Fax:404-593-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5479050001Medicare NSC