Active NPI
Kristy L Pucylowski, PHARMD., RPH
- Pharmacist
- Acworth, GA
National Provider Identifier
1508975764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH021236
- Practice address
- 4469 Lemon St
Acworth, GA 30101-5418 - Phone
- (678) 236-0400
- Fax
- (678) 236-0404
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH021236 | GA | Primary |
Addresses
Primary practice location
4469 Lemon St
Acworth, GA 30101-5418
Mailing address
107 Fairway Overlook
Woodstock, GA 30188-3519
Phone (678) 236-0400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH021236 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lacey Drug Company Inc | Past | Accepting new patients | |
| Lacey Drug Co., Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Marietta, GA
- NPI 1477657898
-
- Long Term Care Pharmacy
- Acworth, GA
- NPI 1023123825
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508975764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 FAIRWAY OVERLOOK",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301883519",
"telephone_number": "678-236-0400",
"fax_number": "678-236-0404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4469 LEMON ST",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301015418",
"telephone_number": "678-236-0400",
"fax_number": "678-236-0404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCYLOWSKI",
"first_name": "KRISTY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHARMD., RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH021236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.