Provider Demographics
NPI:1487164448
Name:OBAWOYE AMBUSH, EVELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:OBAWOYE AMBUSH
Suffix:
Gender:F
Credentials:PHARMD
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 930355
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30003-0355
Mailing Address - Country:US
Mailing Address - Phone:678-428-2897
Mailing Address - Fax:
Practice Address - Street 1:5270 PEACHTREE PKWY STE 114A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2508
Practice Address - Country:US
Practice Address - Phone:678-691-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist