Healthcare Provider Details

I. General information

NPI: 1174248710
Provider Name (Legal Business Name): JOSHUA EFIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 JONESBORO RD
UNION CITY GA
30291-2258
US

IV. Provider business mailing address

3940 JONESBORO RD
UNION CITY GA
30291-2258
US

V. Phone/Fax

Practice location:
  • Phone: 770-774-1161
  • Fax:
Mailing address:
  • Phone: 770-774-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: