Provider Demographics
NPI:1972194504
Name:ASEMOTA, EHIOZOGIE N (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:EHIOZOGIE
Middle Name:N
Last Name:ASEMOTA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2106
Mailing Address - Country:US
Mailing Address - Phone:770-938-6146
Mailing Address - Fax:
Practice Address - Street 1:4317 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2106
Practice Address - Country:US
Practice Address - Phone:770-938-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty