Healthcare Provider Details

I. General information

NPI: 1154035194
Provider Name (Legal Business Name): ANDREW EJIOFOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MCDONOUGH BLVD SE
ATLANTA GA
30315-4400
US

IV. Provider business mailing address

240 GRANT ST SE APT 6322
ATLANTA GA
30312-2558
US

V. Phone/Fax

Practice location:
  • Phone: 404-635-5100
  • Fax:
Mailing address:
  • Phone: 910-385-1139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202221025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: