Individual
BLAISE KOFFI AZIAGBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
794 S PARK ST, CARROLLTON, GA 30117-3826
(770) 838-1678
(770) 838-9352
Mailing address
794 S PARK ST, CARROLLTON, GA 30117-3826
(770) 838-1678
(770) 838-9352
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
19387
AL
183500000X
Pharmacist
Primary
RPH030416
GA
390200000X
Student in an Organized Health Care Education/Training Program
S10581
AL
Other
Enumeration date
05/03/2013
Last updated
12/22/2022
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