Provider Demographics
NPI:1790582203
Name:A&D ATALLA LLC
Entity type:Organization
Organization Name:A&D ATALLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFTIMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH,BS PHARM
Authorized Official - Phone:904-228-2729
Mailing Address - Street 1:8713 OLD KINGS RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4827
Mailing Address - Country:US
Mailing Address - Phone:904-228-2729
Mailing Address - Fax:
Practice Address - Street 1:8713 OLD KINGS RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4827
Practice Address - Country:US
Practice Address - Phone:904-228-2729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy