Provider Demographics
NPI:1912449372
Name:AREGBESOLA, TITILOPE
Entity type:Individual
Prefix:DR
First Name:TITILOPE
Middle Name:
Last Name:AREGBESOLA
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 1:4610 LAKE HILL TRL
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1886
Mailing Address - Country:US
Mailing Address - Phone:678-516-6215
Mailing Address - Fax:
Practice Address - Street 1:4815 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3251
Practice Address - Country:US
Practice Address - Phone:678-494-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist