Healthcare Provider Details

I. General information

NPI: 1043221682
Provider Name (Legal Business Name): YETOLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 FRANKLIN GTWY SE
MARIETTA GA
30067-7707
US

IV. Provider business mailing address

525 FRANKLIN GTWY SE
MARIETTA GA
30067-7707
US

V. Phone/Fax

Practice location:
  • Phone: 678-581-1223
  • Fax: 678-581-2356
Mailing address:
  • Phone: 678-581-1223
  • Fax: 678-581-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHRE008552
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YETUNDE EZEANII
Title or Position: CEO
Credential:
Phone: 678-581-1223