Individual
IDIA V. OKPEBHOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5095 MOUNT ZION PKWY, STOCKBRIDGE, GA 30281-7825
(770) 461-3431
Mailing address
5095 MOUNT ZION PKWY, STOCKBRIDGE, GA 30281-7825
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH030685
GA
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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