Organization
JOSELIGLO INC
Active
Other names
Open Gate Pharmacy #3
Organization subpart
No
Provider details
NPI number
Authorized official
MOJISOLA EVBUOMWAN PHARMD (PRESIDENT)
(706) 323-0306
Entity
Organization
Contact information
Practice address
1714 MANCHESTER EXPY, COLUMBUS, GA 31904-6748
(706) 225-0022
(706) 225-0020
Mailing address
2051 10TH AVE, COLUMBUS, GA 31901-1459
(706) 323-0306
(706) 327-3824
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010162
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003167027A
—
GA
01
—
2153699
PK
—
Enumeration date
12/23/2010
Last updated
11/06/2024
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