PROVIDENCE PHARMACY INC
Suppliers at Broad St, Fairburn, GA

License number
Georgia PHHH000044
Category
Suppliers
Type
Community/Retail Pharmacy
Owner
Name: CLEMENT E OKPALA RPH
Title: OWNER
Phone: (678) 362-6576
Address
Address
216 NW Broad St SUITE B, Fairburn, GA 30213
National Provider ID: 1942436027
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PROVIDENCE PHARMACY, INC

216 W Broad St SUITE B, Fairburn, GA 30213

Doing business as:
Providence Pharmacy
Registration:
Oct 14, 2008
Phone:
(678) 489-8093 (Phone)
State ID:
08078609
Business type:
Domestic Profit Corporation
CFOs:
Emeka Clement Okpala (Secretary), 216 W Broad St #13, Fairburn, GA 30213 (Physical),Ngozi Stella Okpala (CFO), 216 W Broad St #13, Fairburn, GA 30213 (Physical)
Agent:
Clement E Okpala,216 W Broad Stret SUITE B, Fairburn, GA (Physical)
Categories:
Drug Stores & Pharmacies

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