Provider Demographics
NPI:1164705091
Name:OKIBEDI, ALPHONSE OKECHUKWU JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:OKECHUKWU
Last Name:OKIBEDI
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 CHASEFORD LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5637
Mailing Address - Country:US
Mailing Address - Phone:404-402-2902
Mailing Address - Fax:
Practice Address - Street 1:5000 FLOYD RD SW
Practice Address - Street 2:M
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1608
Practice Address - Country:US
Practice Address - Phone:770-819-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist