Provider Demographics
NPI:1336426089
Name:ATLAS MEDICAL INC
Entity Type:Organization
Organization Name:ATLAS MEDICAL INC
Other - Org Name:ATLAS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-385-3143
Mailing Address - Street 1:5037 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6812
Mailing Address - Country:US
Mailing Address - Phone:386-385-3143
Mailing Address - Fax:386-385-3377
Practice Address - Street 1:5037 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6812
Practice Address - Country:US
Practice Address - Phone:386-385-3143
Practice Address - Fax:386-385-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH257983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5708625OtherNCPDP PROVIDER IDENTIFICATION NUMBER