Provider Demographics
NPI:1497355465
Name:YIGEZU, FASIKA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FASIKA
Middle Name:
Last Name:YIGEZU
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 1:2609 PETERBORO ROW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5877
Mailing Address - Country:US
Mailing Address - Phone:404-543-5916
Mailing Address - Fax:
Practice Address - Street 1:3100 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5657
Practice Address - Country:US
Practice Address - Phone:404-543-5916
Practice Address - Fax:770-642-1493
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist