Individual
EKU OBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1029 FOREST PKWY, FOREST PARK, GA 30297-2350
(404) 819-7795
Mailing address
1029 FOREST PKWY, FOREST PARK, GA 30297-2350
(404) 819-7795
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
030788
GA
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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