Healthcare Provider Details

I. General information

NPI: 1154678167
Provider Name (Legal Business Name): ADA OPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3346 BRIDGE WALK DR
LAWRENCEVILLE GA
30044-5125
US

IV. Provider business mailing address

3346 BRIDGE WALK DR
LAWRENCEVILLE GA
30044-5125
US

V. Phone/Fax

Practice location:
  • Phone: 770-655-1161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH023351
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: