Provider Demographics
NPI:1003129578
Name:JALO, MONIFA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:MONIFA
Middle Name:
Last Name:JALO
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 S COBB DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6975
Mailing Address - Country:US
Mailing Address - Phone:678-293-5205
Mailing Address - Fax:678-293-5269
Practice Address - Street 1:4585 S COBB DR SE STE 300
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6975
Practice Address - Country:US
Practice Address - Phone:678-293-5205
Practice Address - Fax:678-293-5269
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
GA021894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist