Provider Demographics
NPI:1598375826
Name:SEYOUM, MULUKEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MULUKEN
Middle Name:
Last Name:SEYOUM
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 1:6678 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4809
Mailing Address - Country:US
Mailing Address - Phone:770-593-7111
Mailing Address - Fax:770-593-1054
Practice Address - Street 1:6678 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4809
Practice Address - Country:US
Practice Address - Phone:770-593-7111
Practice Address - Fax:770-593-1054
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0229291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist