Provider Demographics
NPI:1235441031
Name:FASORANTI, KEHINDE 0 (RPH)
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:0
Last Name:FASORANTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 HAMILTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4106
Mailing Address - Country:US
Mailing Address - Phone:470-783-0199
Mailing Address - Fax:
Practice Address - Street 1:2605 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4106
Practice Address - Country:US
Practice Address - Phone:470-783-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038211L183500000X
NJ28RI03118400183500000X
GARPH034213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist