Provider Demographics
NPI:1124651112
Name:BAILEY, TITILOLA AYOOLA (RPH)
Entity type:Individual
Prefix:
First Name:TITILOLA
Middle Name:AYOOLA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TITILOLA
Other - Middle Name:AYOOLA
Other - Last Name:OKUPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1275 POWERS FERRY RD SE STE 170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9487
Mailing Address - Country:US
Mailing Address - Phone:770-272-9612
Mailing Address - Fax:770-272-9613
Practice Address - Street 1:1275 POWERS FERRY RD SE STE 170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9487
Practice Address - Country:US
Practice Address - Phone:770-272-9612
Practice Address - Fax:770-272-9613
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist