Provider Demographics
NPI:1770866493
Name:AGYEMAN, LISA OFORI
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:OFORI
Last Name:AGYEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 TARA BLVD
Mailing Address - Street 2:WALGREENS
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2205
Mailing Address - Country:US
Mailing Address - Phone:678-479-1976
Mailing Address - Fax:678-479-3406
Practice Address - Street 1:7935 TARA BOULEVARD
Practice Address - Street 2:WALGREENS
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:678-479-1976
Practice Address - Fax:678-479-3406
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist