Provider Demographics
NPI:1427460757
Name:MCARTHURS APOTHECARY
Entity type:Organization
Organization Name:MCARTHURS APOTHECARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-735-9200
Mailing Address - Street 1:593 EDGEWOOD AVE SE STE 200B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1935
Mailing Address - Country:US
Mailing Address - Phone:404-523-6337
Mailing Address - Fax:678-705-3924
Practice Address - Street 1:593 EDGEWOOD AVE SE STE 200B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1935
Practice Address - Country:US
Practice Address - Phone:404-523-6337
Practice Address - Fax:678-705-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
GAPHRE0101723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003174263AMedicaid
2153983OtherPK