Provider Demographics
NPI:1124916556
Name:PCI PHARMACY INC
Entity type:Organization
Organization Name:PCI PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MBA
Authorized Official - Middle Name:UKOHA
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-549-8447
Mailing Address - Street 1:3500 N DECATUR RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-6817
Mailing Address - Country:US
Mailing Address - Phone:404-625-3566
Mailing Address - Fax:
Practice Address - Street 1:3500 N DECATUR RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-6817
Practice Address - Country:US
Practice Address - Phone:404-625-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PCI PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190274AMedicaid