Providence Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PROVIDENCE PHARMACY INC

Practice address

180 W Broad St Ste a
Fairburn, GA 30213

Phone

(678) 489-2069

Fax

(678) 489-8627

NPI assigned

Jun 3, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clement Emeka Okpala, PHARMDNPI 1326379280

Title

Ceo

Phone

(678) 489-2069

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PROVIDENCE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clement Emeka Okpala, PHARMD

  • Pharmacotherapy Pharmacist
  • Fairburn, GA
  • NPI 1326379280
  NPD Authorized official
• Stella Ngozi Okpala

  • Pharmacotherapy Pharmacist
  • Fairburn, GA
  • NPI 1578889119
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1942436027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 W BROAD ST STE A",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "30213",
            "telephone_number": "678-489-2069",
            "fax_number": "678-489-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 W BROAD ST STE A",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "30213",
            "telephone_number": "678-489-2069",
            "fax_number": "678-489-8627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "180 W Broad St Ste A",
            "address_purpose": "LOCATION",
            "city": "Fairburn",
            "state": "GA",
            "postal_code": "30213",
            "country_code": "US",
            "telephone_number": "678-489-2069",
            "fax_number": "678-489-8627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-03",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "OKPALA",
        "authorized_official_first_name": "CLEMENT",
        "authorized_official_middle_name": "EMEKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-489-2069",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054275159A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexa Angelina Preyer, PT, DPT
• Shaqueena Denise Price, RBT
• Proficient in Home Care Services Inc
• Marvo Brenda Prosper Azille, RN
• Providence Care Inc
• Providers of Hope
• Pruitthealth - Fairburn, LLC
• Psalms 71 Inc.
• Publix Super Markets Inc
• Quality Personal Care, Inc.

• Community/Retail Pharmacy in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.