Provider Demographics
NPI:1073105417
Name:OPEIFA, FOLUKE ADETOLA
Entity Type:Individual
Prefix:MS
First Name:FOLUKE
Middle Name:ADETOLA
Last Name:OPEIFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 WEDGEWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1347
Mailing Address - Country:US
Mailing Address - Phone:678-534-9811
Mailing Address - Fax:
Practice Address - Street 1:6409 WEDGEWOOD TRCE
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1347
Practice Address - Country:US
Practice Address - Phone:678-534-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022352183500000X
WI13433-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist