Provider Demographics
NPI:1932494473
Name:KAT INTERNATIONAL GROUP INC
Entity Type:Organization
Organization Name:KAT INTERNATIONAL GROUP INC
Other - Org Name:FAIRWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMPSON
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYEMANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-493-5959
Mailing Address - Street 1:1750 MARIETTA HWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8387
Mailing Address - Country:US
Mailing Address - Phone:678-493-5959
Mailing Address - Fax:678-493-3546
Practice Address - Street 1:1750 MARIETTA HWY STE 260
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8388
Practice Address - Country:US
Practice Address - Phone:678-493-5959
Practice Address - Fax:678-493-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0097613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110325Medicaid
1161570OtherNCPDP PROVIDER IDENTIFICATION NUMBER