Healthcare Provider Details

I. General information

NPI: 1306126842
Provider Name (Legal Business Name): PHEBAH FIJI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CENTERVILLE HWY
SNELLVILLE GA
30039-6405
US

IV. Provider business mailing address

3441 DONEGAL WAY
SNELLVILLE GA
30039-8635
US

V. Phone/Fax

Practice location:
  • Phone: 770-736-2157
  • Fax:
Mailing address:
  • Phone: 678-344-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024185
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: