Healthcare Provider Details

I. General information

NPI: 1730783903
Provider Name (Legal Business Name): CHRISTIANA OKWARA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 11/28/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 ATLANTA HWY
LOGANVILLE GA
30052-2642
US

IV. Provider business mailing address

4377 ATLANTA HWY
LOGANVILLE GA
30052-2642
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-0109
  • Fax: 770-554-6098
Mailing address:
  • Phone: 770-466-0109
  • Fax: 770-554-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: