Provider Demographics
NPI:1902206170
Name:ATAKEY, EDEM Y (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EDEM
Middle Name:Y
Last Name:ATAKEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 ULLYOT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2119
Mailing Address - Country:US
Mailing Address - Phone:774-386-1710
Mailing Address - Fax:
Practice Address - Street 1:907 LINCOLN HWY W
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2141
Practice Address - Country:US
Practice Address - Phone:260-493-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025802A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist