Provider Demographics
NPI:1215538103
Name:OKOYE, AGATHA NONYE
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:NONYE
Last Name:OKOYE
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 1:5300 BRIDLE POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2715
Mailing Address - Country:US
Mailing Address - Phone:404-578-3918
Mailing Address - Fax:
Practice Address - Street 1:5300 BRIDLE POINT PKWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-2715
Practice Address - Country:US
Practice Address - Phone:404-578-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist