Organization
EXCELSIOR SPECIALTY PHARMACY INC
Active
Other names
EXCELSIOR SPECIALTY PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM KITSON (OWNER/PIC/AO)
(678) 428-7325
Entity
Organization
Contact information
Practice address
3652 CHAMBLEE DUNWOODY RD STE 3, ATLANTA, GA 30341-2120
(470) 222-8320
(470) 222-8229
Mailing address
3652 CHAMBLEE DUNWOODY RD STE 3, ATLANTA, GA 30341-2120
(470) 222-8320
(470) 222-8229
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010404
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003198495A
—
GA
01
—
2173269
PK
—
Enumeration date
11/09/2017
Last updated
04/19/2018
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