Healthcare Provider Details

I. General information

NPI: 1952299869
Provider Name (Legal Business Name): OMOPELUMI OLUWADAMILOLA KUKU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 ROYAL DR STE 100
ALPHARETTA GA
30022-2476
US

IV. Provider business mailing address

3155 ROYAL DR STE 100
ALPHARETTA GA
30022-2476
US

V. Phone/Fax

Practice location:
  • Phone: 770-496-7400
  • Fax:
Mailing address:
  • Phone: 770-686-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH035435
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: