Provider Demographics
NPI:1538453345
Name:FARIYIKE, EMMANUEL I
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:I
Last Name:FARIYIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 ECHO MILL CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4984
Mailing Address - Country:US
Mailing Address - Phone:678-457-7989
Mailing Address - Fax:678-567-2915
Practice Address - Street 1:520 BOULEVARD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3428
Practice Address - Country:US
Practice Address - Phone:404-624-0022
Practice Address - Fax:404-627-0309
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist