Individual
CLETUS AHIDJO FOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2935 FIVE FORKS TRICKUM RD, LAWRENCEVILLE, GA 30044-5895
(770) 982-5202
Mailing address
2412 CHANCE LN, GRAYSON, GA 30017-7867
(678) 793-6496
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH024164
GA
Other
Enumeration date
01/17/2013
Last updated
02/01/2021
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