Provider Demographics
NPI:1851865893
Name:RX MART PHARMACY
Entity Type:Organization
Organization Name:RX MART PHARMACY
Other - Org Name:RX MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEKWUECHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-672-0304
Mailing Address - Street 1:3485 ACWORTH DUE WEST RD NW STE 130
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3485 ACWORTH DUE WEST RD NW STE 130
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3865
Practice Address - Country:US
Practice Address - Phone:770-672-0304
Practice Address - Fax:770-627-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-13
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy