Healthcare Provider Details

I. General information

NPI: 1093683575
Provider Name (Legal Business Name): CHINYERE UKEGBU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UPPER RIVERDALE ROAD
RIVERDALE GA
30274
US

IV. Provider business mailing address

472 CRESTBEND LN
POWDER SPRINGS GA
30127-5706
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-8000
  • Fax:
Mailing address:
  • Phone: 770-991-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033380
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: