MEDICARE: DR. MICHELLE D. OPPONG PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	021465	GA

General Provider Information

NPI Number	:	1205833290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE D. OPPONG PHARM.D.

Provider Business Mailing Address
First Line	:	4752 IVY RIDGE DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6628
Country	:	US
Telephone Number	:	404-277-6295
Fax Number	:	866-430-8387

Provider Business Practice Location Address
First Line	:	55 IVAN ALLEN JR BLVD NW
Second Line	:	HEALTH SCIENCE ADVISORY SERVICES
City	:	ATLANTA
State	:	GA
Zip	:	30308-3050
Country	:	US
Telephone Number	:	404-616-0134
Fax Number	:	404-616-6070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/05/2008

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