Individual
CHIBUIKEM HENRY EZEASOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
215 BROOKESTONE PT, FAYETTEVILLE, GA 30215-8241
(678) 860-1129
Mailing address
215 BROOKESTONE PT, FAYETTEVILLE, GA 30215-8241
(678) 860-1129
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH029272
GA
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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