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Organization
PROVIDENCE PHARMACY INC
Active
Organization
PROVIDENCE PHARMACY INC
Active
Other names
PROVIDENCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CLEMENT EMEKA OKPALA PHARMD (CEO)
(678) 489-2069
Entity
Organization
Contact information
Practice address
180 W BROAD ST STE A, FAIRBURN, GA 30213
(678) 489-2069
(678) 489-8627
Mailing address
180 W BROAD ST STE A, FAIRBURN, GA 30213
(678) 489-2069
(678) 489-8627
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Enumeration date
06/03/2009
Last updated
03/11/2021
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