Provider Demographics
NPI:1023609211
Name:MOGHALU, JULIET C
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:C
Last Name:MOGHALU
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 1:2222 E WEST CONNECTOR APT 509
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8188
Mailing Address - Country:US
Mailing Address - Phone:404-509-0846
Mailing Address - Fax:
Practice Address - Street 1:4860 STONE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4618
Practice Address - Country:US
Practice Address - Phone:770-972-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0312311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist