Provider Demographics
NPI:1710242649
Name:GICHURU, MARY NJERI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:NJERI
Last Name:GICHURU
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 1:11 BROOKVALLEY CT E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1615
Mailing Address - Country:US
Mailing Address - Phone:678-557-8512
Mailing Address - Fax:
Practice Address - Street 1:11 BROOKVALLEY CT E
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1615
Practice Address - Country:US
Practice Address - Phone:678-557-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027145183500000X
TN36165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist