Provider Demographics
NPI:1578889119
Name:OKPALA, STELLA NGOZI
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:NGOZI
Last Name:OKPALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WEST BROAD STREET SUIT B
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213
Mailing Address - Country:US
Mailing Address - Phone:678-489-2069
Mailing Address - Fax:678-489-8627
Practice Address - Street 1:216 NW BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4106
Practice Address - Country:US
Practice Address - Phone:678-489-2069
Practice Address - Fax:678-489-8627
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0215991835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy