# PROVIDENCE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942436027
- **Authorized official:** CLEMENT EMEKA OKPALA PHARMD (CEO)
- **Authorized official phone:** (678) 489-2069

## Contact information

- **Practice address:** 180 W BROAD ST STE A, FAIRBURN, GA 30213
- **Practice address phone:** (678) 489-2069
- **Practice address fax:** (678) 489-8627
- **Mailing address:** 180 W BROAD ST STE A, FAIRBURN, GA 30213
- **Mailing address phone:** (678) 489-2069
- **Mailing address fax:** (678) 489-8627

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/03/2009
- **Last updated:** 03/11/2021