=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154713360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESTHER AYUK MPH,RPH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2015
-----------------------------------------------------
Last Update Date | 02/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 VETERANS MEMORIAL HWY SE SUITE 128
-----------------------------------------------------
City | MABLETON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30126-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-714-2846
-----------------------------------------------------
Fax | 404-699-0117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 VETERANS MEMORIAL HWY SE SUITE 128
-----------------------------------------------------
City | MABLETON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30126-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-714-2846
-----------------------------------------------------
Fax | 404-699-0117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH018086
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------