Provider Demographics
NPI:1639807977
Name:ANYANWU, IJEOMA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:IJEOMA
Middle Name:
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 REMINGTON PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-0401
Mailing Address - Country:US
Mailing Address - Phone:678-849-4268
Mailing Address - Fax:
Practice Address - Street 1:2596 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-8300
Practice Address - Country:US
Practice Address - Phone:404-799-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist