Organization
PCCA INC
Active
Other names
Dunwoody Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES WILSON RPH (OWNER PHARMACIST)
(770) 455-1144
Entity
Organization
Contact information
Practice address
4675 N SHALLOWFORD RD, STE 101, DUNWOODY, GA 30338-6309
(770) 455-1144
(770) 936-8989
Mailing address
4675 N SHALLOWFORD RD, STE 101, DUNWOODY, GA 30338-6309
(770) 455-1144
(770) 936-8989
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
6006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00655256A
—
GA
01
—
2015883
PK
—
Enumeration date
08/10/2006
Last updated
05/22/2024
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