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General NPI Number Information
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NPI Number | 1326346693
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Entity Type | Individual
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Provider Name | DR. HENRIETTA CHIBUGO OBIALO-NZERUE
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Gender | Female
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 2240 SALEM RD SE
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City | CONYERS
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State | GA
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Zip | 30013-1843
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Country | US
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Telephone | 770-929-8711
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Fax | 770-483-7516
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Provider Business Mailing Address
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Address Line | 2240 SALEM ROAD,SOUTH EAST
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City | CONYERS
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State | GA
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Zip | 30013
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Country | US
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Telephone | 770-929-8711
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Fax | 770-483-7516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH020884
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License Number State | GA
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