Individual
EBOSETALE IKHELOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2550 BLACKMON DR APT 3211, DECATUR, GA 30033-6254
(706) 351-0246
Mailing address
2550 BLACKMON DR APT 3211, DECATUR, GA 30033-6254
(706) 351-0246
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH033510
GA
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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