Provider Demographics
NPI:1194167767
Name:PINEDA, OFELIA MARIA
Entity type:Individual
Prefix:
First Name:OFELIA
Middle Name:MARIA
Last Name:PINEDA
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 1:3875 AUSTELL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-944-9101
Mailing Address - Fax:770-944-7702
Practice Address - Street 1:3875 AUSTELL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1103
Practice Address - Country:US
Practice Address - Phone:770-944-9101
Practice Address - Fax:770-944-7702
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist