Provider Demographics
NPI:1518266121
Name:UKUEKU-BOYO, ESEROGHENE (BS PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:ESEROGHENE
Middle Name:
Last Name:UKUEKU-BOYO
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 SUNSET RDG
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4505
Mailing Address - Country:US
Mailing Address - Phone:770-792-7061
Mailing Address - Fax:770-222-8823
Practice Address - Street 1:4481 HIRAM LITHIA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-3024
Practice Address - Country:US
Practice Address - Phone:770-439-1779
Practice Address - Fax:770-222-8823
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist