Healthcare Provider Details

I. General information

NPI: 1215538103
Provider Name (Legal Business Name): AGATHA NONYE OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BRIDLE POINT PKWY
SNELLVILLE GA
30039-2715
US

IV. Provider business mailing address

5300 BRIDLE POINT PKWY
SNELLVILLE GA
30039-2715
US

V. Phone/Fax

Practice location:
  • Phone: 404-578-3918
  • Fax:
Mailing address:
  • Phone: 404-578-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: