Healthcare Provider Details

I. General information

NPI: 1841115912
Provider Name (Legal Business Name): ORITSEMISAN EJUTSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISAN EJUTSE PHARMD

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

3200 MOON BEAM CT
SNELLVILLE GA
30039-6130
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1000
  • Fax:
Mailing address:
  • Phone: 404-844-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH036052
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: