Healthcare Provider Details

I. General information

NPI: 1114522836
Provider Name (Legal Business Name): DAVID OWIREDU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 GEORGIA HIGHWAY 20 NE
CONYERS GA
30012-3834
US

IV. Provider business mailing address

1511 KATHRYNS GLN SE
CONYERS GA
30013-7463
US

V. Phone/Fax

Practice location:
  • Phone: 770-929-0310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: