Provider Demographics
NPI:1740563170
Name:IZUNDU, NNEKA ANULI (PHARM MD)
Entity Type:Individual
Prefix:DR
First Name:NNEKA
Middle Name:ANULI
Last Name:IZUNDU
Suffix:
Gender:F
Credentials:PHARM MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 WILD RYE LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4198
Mailing Address - Country:US
Mailing Address - Phone:404-547-1735
Mailing Address - Fax:
Practice Address - Street 1:5320 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3201
Practice Address - Country:US
Practice Address - Phone:404-508-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist