Provider Demographics
NPI:1043462575
Name:IGBINOBA OKOJIE, OSARHIEME C (RPH)
Entity Type:Individual
Prefix:
First Name:OSARHIEME
Middle Name:C
Last Name:IGBINOBA OKOJIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 REDAN CIR STE B
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3411
Mailing Address - Country:US
Mailing Address - Phone:678-694-8836
Mailing Address - Fax:678-694-8839
Practice Address - Street 1:5529 REDAN CIR STE B
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3411
Practice Address - Country:US
Practice Address - Phone:678-694-8836
Practice Address - Fax:678-694-8839
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist