Healthcare Provider Details

I. General information

NPI: 1497053532
Provider Name (Legal Business Name): UKOS DENNY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2011
Last Update Date: 03/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6094 MABLETON PKWY SW
MABLETON GA
30126-3463
US

IV. Provider business mailing address

6094 MABLETON PKWY SW
MABLETON GA
30126-3463
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-3331
  • Fax:
Mailing address:
  • Phone: 770-944-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009734
License Number StateGA

VIII. Authorized Official

Name: DR. THOMAS UKOSHOVBERA GBENEDIO
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 770-944-3331