Provider Demographics
NPI:1891830303
Name:B & K DRUGSTORES INC
Entity Type:Organization
Organization Name:B & K DRUGSTORES INC
Other - Org Name:EXPRESS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHOLAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKHTIARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-688-2211
Mailing Address - Street 1:212 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2607
Mailing Address - Country:US
Mailing Address - Phone:404-688-2211
Mailing Address - Fax:404-688-2226
Practice Address - Street 1:212 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2607
Practice Address - Country:US
Practice Address - Phone:404-688-2211
Practice Address - Fax:404-688-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00858932AMedicaid
GA4035660001Medicare NSC