Provider Demographics
NPI:1437664612
Name:TABE-EBOB, CATHERINE EBOK (PHARMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:EBOK
Last Name:TABE-EBOB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 CROSSFIRE RDG NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1396
Mailing Address - Country:US
Mailing Address - Phone:505-507-9371
Mailing Address - Fax:
Practice Address - Street 1:2425 N SLAPPEY BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1009
Practice Address - Country:US
Practice Address - Phone:229-883-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist