Provider Demographics
NPI:1043814718
Name:EBRAHIMJI, HUZEFA
Entity Type:Individual
Prefix:
First Name:HUZEFA
Middle Name:
Last Name:EBRAHIMJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 AXTON CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5217
Mailing Address - Country:US
Mailing Address - Phone:864-597-9766
Mailing Address - Fax:
Practice Address - Street 1:1140 N HAIRSTON RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5800
Practice Address - Country:US
Practice Address - Phone:404-292-0484
Practice Address - Fax:404-299-3629
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH22998183500000X
SC9730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist