Provider Demographics
NPI:1053916312
Name:ONWUKA, IFEANYI JAKE (PHARMD)
Entity type:Individual
Prefix:
First Name:IFEANYI
Middle Name:JAKE
Last Name:ONWUKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 MABLETON PKWY SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3471
Mailing Address - Country:US
Mailing Address - Phone:770-745-3171
Mailing Address - Fax:
Practice Address - Street 1:5846 MABLETON PKWY SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3471
Practice Address - Country:US
Practice Address - Phone:770-745-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist