Active NPI
Shadi Yacoub, PHARMD
- Pharmacist
- Brookhaven, GA
National Provider Identifier
1871372342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH034564
- Practice address
- 104 Town Blvd NE Ste A100
Brookhaven, GA 30319-3146 - Phone
- (404) 233-7480
- NPI assigned
- Sep 25, 2023
- Last updated
- Sep 25, 2023
- Sex
- Male
- 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 | RPH034564 | GA | Primary |
Addresses
Primary practice location
104 Town Blvd NE Ste A100
Brookhaven, GA 30319-3146
Mailing address
2230 Cheshire Bridge Rd NE Unit 512
Atlanta, GA 30324-4281
Phone (404) 593-1743
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH034564 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients | |
| Publix Super Markets 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Publix Pharmacy #1363
- Community/Retail Pharmacy
- Brookhaven, GA
- NPI 1417247701
-
dba Publix Pharmacy #2107
- Community/Retail Pharmacy
- Winter Haven, FL
- NPI 1760356380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1871372342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2230 CHESHIRE BRIDGE RD NE UNIT 512",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303244281",
"telephone_number": "404-593-1743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 TOWN BLVD NE STE A100",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303193146",
"telephone_number": "404-233-7480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YACOUB",
"first_name": "SHADI",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-25",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH034564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.