Provider Demographics
NPI:1770882763
Name:IGBOKWE, ANDREW O
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:O
Last Name:IGBOKWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-0185
Mailing Address - Country:US
Mailing Address - Phone:770-991-9963
Mailing Address - Fax:
Practice Address - Street 1:1638 HIGHWAY 138 E
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3800
Practice Address - Country:US
Practice Address - Phone:770-472-1205
Practice Address - Fax:770-472-3886
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist