Provider Demographics
NPI:1629337514
Name:ADEM, FOZI OUSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FOZI
Middle Name:OUSE
Last Name:ADEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:FOZI
Other - Middle Name:OUSE
Other - Last Name:ADEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 SOUTH LINK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014
Mailing Address - Country:US
Mailing Address - Phone:678-625-0230
Mailing Address - Fax:
Practice Address - Street 1:3140 TURNER HILL ROAD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038
Practice Address - Country:US
Practice Address - Phone:678-323-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist