Provider Demographics
NPI:1780605006
Name:ATKINS APOTHECARY
Entity type:Organization
Organization Name:ATKINS APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-422-0555
Mailing Address - Street 1:30 S FAIRGROUND ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2367
Mailing Address - Country:US
Mailing Address - Phone:770-422-0555
Mailing Address - Fax:770-422-0534
Practice Address - Street 1:30 S FAIRGROUND ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2367
Practice Address - Country:US
Practice Address - Phone:770-422-0555
Practice Address - Fax:770-422-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0045633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1240430001Medicare ID - Type Unspecified