Provider Demographics
NPI:1598357097
Name:IKE, IROEMEHA CHRISTIAN (RPH)
Entity Type:Individual
Prefix:
First Name:IROEMEHA
Middle Name:CHRISTIAN
Last Name:IKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 BATEMAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5039
Mailing Address - Country:US
Mailing Address - Phone:770-464-4330
Mailing Address - Fax:770-464-4323
Practice Address - Street 1:1027 BATEMAN DR STE A
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5039
Practice Address - Country:US
Practice Address - Phone:770-464-4330
Practice Address - Fax:770-464-4323
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist