Provider Demographics
NPI:1891542064
Name:EZECHUKWU, EUNICE AMAKA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:AMAKA
Last Name:EZECHUKWU
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 1:5262 KINSDALE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4304
Mailing Address - Country:US
Mailing Address - Phone:404-861-9543
Mailing Address - Fax:
Practice Address - Street 1:3045 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2317
Practice Address - Country:US
Practice Address - Phone:770-322-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist