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NPI Code Detail

MEDICARE: EKU OBEN

MEDICARE: EKU OBEN
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
1183500000XPharmacist030788GA

General Provider Information

NPI Number : 1356945729
Entity Type Code : Individual
Provider Name (Legal Business Name) : EKU OBEN
Provider Business Mailing Address
First Line : 1029 FOREST PKWY
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-2350
Country : US
Telephone Number : 404-819-7795
Fax Number :
Provider Business Practice Location Address
First Line : 1029 FOREST PKWY
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-2350
Country : US
Telephone Number : 404-819-7795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2020
Last Update Date : 11/25/2020

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Directions to “ EKU OBEN ” Practice Location

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