Healthcare Provider Details

I. General information

NPI: 1841623501
Provider Name (Legal Business Name): ECHEZONA ANSELM OKOLI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2013
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CINEMA DR
ELLIJAY GA
30540-2592
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-635-6898
  • Fax: 706-635-6823
Mailing address:
  • Phone: 706-946-5607
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: