Provider Demographics
NPI:1982099636
Name:GLOJOSELI INC
Entity Type:Organization
Organization Name:GLOJOSELI INC
Other - Org Name:OPEN GATE PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJISOLA
Authorized Official - Middle Name:OMOBIKE
Authorized Official - Last Name:EVBUOMWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-662-2400
Mailing Address - Street 1:2051 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1459
Mailing Address - Country:US
Mailing Address - Phone:706-662-2400
Mailing Address - Fax:
Practice Address - Street 1:1807 S LUMPKIN RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-2794
Practice Address - Country:US
Practice Address - Phone:706-940-0365
Practice Address - Fax:706-507-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0101353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151114OtherPK