Organization
NAS DECATUR LLC
Active
Other names
McKinney's Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR SHAH PHARMD (OWNER)
(706) 825-8182
Entity
Organization
Contact information
Practice address
225 E PONCE DE LEON AVE, SUITE 140, DECATUR, GA 30030-3444
(404) 378-5408
(404) 378-5400
Mailing address
225 E PONCE DE LEON AVE, SUITE 140, DECATUR, GA 30030-3444
(404) 378-5408
(404) 378-5400
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE003374
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00031523A
—
GA
01
—
2012320
PK
—
Enumeration date
09/12/2006
Last updated
08/02/2022
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