Provider Demographics
NPI:1134687775
Name:ORUBELE, EMELIA ADA (RPH)
Entity Type:Individual
Prefix:
First Name:EMELIA
Middle Name:ADA
Last Name:ORUBELE
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 1:5855 JIMMY CARTER BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4610
Mailing Address - Country:US
Mailing Address - Phone:678-879-0721
Mailing Address - Fax:678-893-0942
Practice Address - Street 1:5855 JIMMY CARTER BLVD STE 190
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4610
Practice Address - Country:US
Practice Address - Phone:678-879-0721
Practice Address - Fax:678-893-0942
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH017342OtherGA BOARD OF PHARMACY