Provider Demographics
NPI:1912662974
Name:OMOREGIE, OSARETIN PEGGY (PHARM D)
Entity Type:Individual
Prefix:
First Name:OSARETIN
Middle Name:PEGGY
Last Name:OMOREGIE
Suffix:
Gender:F
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 1:112 WOODBERRY PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5548
Mailing Address - Country:US
Mailing Address - Phone:678-235-1727
Mailing Address - Fax:
Practice Address - Street 1:4200 SALEM RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4533
Practice Address - Country:US
Practice Address - Phone:678-212-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0328743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy