Active NPI
Ebosetale Ikheloa
- Pharmacist
- Decatur, GA
National Provider Identifier
1457170649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH033510
- Practice address
- 2550 Blackmon Dr Apt 3211
Decatur, GA 30033-6254 - Phone
- (706) 351-0246
- NPI assigned
- Oct 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH033510 | GA | Primary |
Addresses
Primary practice location
2550 Blackmon Dr Apt 3211
Decatur, GA 30033-6254
Mailing address
2550 Blackmon Dr Apt 3211
Decatur, GA 30033-6254
Phone (706) 351-0246
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH033510 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1457170649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 BLACKMON DR APT 3211",
"city": "DECATUR",
"state": "GA",
"postal_code": "300336254",
"telephone_number": "706-351-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 BLACKMON DR APT 3211",
"city": "DECATUR",
"state": "GA",
"postal_code": "300336254",
"telephone_number": "706-351-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKHELOA",
"first_name": "EBOSETALE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-07",
"certification_date": "2024-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH033510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.