Provider Demographics
NPI:1376109025
Name:OBIAKO, ADIRIKA JUSTIN
Entity Type:Individual
Prefix:DR
First Name:ADIRIKA
Middle Name:JUSTIN
Last Name:OBIAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 WESTGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-5607
Mailing Address - Country:US
Mailing Address - Phone:334-677-6760
Mailing Address - Fax:334-677-5845
Practice Address - Street 1:1571 WESTGATE PKWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-5607
Practice Address - Country:US
Practice Address - Phone:334-677-6760
Practice Address - Fax:334-677-5845
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1346261625Medicaid