Provider Demographics
NPI:1326346693
Name:OBIALO-NZERUE, HENRIETTA CHIBUGO
Entity Type:Individual
Prefix:DR
First Name:HENRIETTA
Middle Name:CHIBUGO
Last Name:OBIALO-NZERUE
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 1:2240 SALEM ROAD,SOUTH EAST
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013
Mailing Address - Country:US
Mailing Address - Phone:770-929-8711
Mailing Address - Fax:770-483-7516
Practice Address - Street 1:2240 SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1843
Practice Address - Country:US
Practice Address - Phone:770-929-8711
Practice Address - Fax:770-483-7516
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist