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NPI Code Detail

MEDICARE: KEHINDE 0 FASORANTI R.PH

MEDICARE: KEHINDE 0 FASORANTI R.PH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRP038211LPA
2183500000XPharmacist28RI03118400NJ
3183500000XPharmacistRPH034213GA

General Provider Information

NPI Number : 1235441031
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEHINDE 0 FASORANTI R.PH
Provider Business Mailing Address
First Line : 2605 HAMILTON MILL RD
Second Line :
City : BUFORD
State : GA
Zip : 30519-4106
Country : US
Telephone Number : 470-783-0199
Fax Number :
Provider Business Practice Location Address
First Line : 2605 HAMILTON MILL RD
Second Line :
City : BUFORD
State : GA
Zip : 30519-4106
Country : US
Telephone Number : 470-783-0199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2010
Last Update Date : 08/31/2023

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