Provider Demographics
NPI:1255328613
Name:BABALOLA-ERINLE, MARIE A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:BABALOLA-ERINLE
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 1:425 MOUNTAIN PARK TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5712
Mailing Address - Country:US
Mailing Address - Phone:770-498-4947
Mailing Address - Fax:
Practice Address - Street 1:GRADY OUT PATIENT PHARMACY, GRADY HEALTH SYSTEMS
Practice Address - Street 2:80, JESSIE HILL JR DR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-0368
Practice Address - Fax:404-616-8651
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist