Provider Demographics
NPI:1376823765
Name:YABA, TOCHUKWU (PHARMD)
Entity Type:Individual
Prefix:
First Name:TOCHUKWU
Middle Name:
Last Name:YABA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 ASHFORD DUNWOODY RD
Mailing Address - Street 2:STE. A273
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4780 ASHFORD DUNWOODY RD
Practice Address - Street 2:STE. A273
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5564
Practice Address - Country:US
Practice Address - Phone:202-580-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist