Provider Demographics
NPI:1538771738
Name:GITAU, JOHN NGURE (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NGURE
Last Name:GITAU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:NGURE
Other - Last Name:GITAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:385 FRANKLIN LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-3711
Mailing Address - Country:US
Mailing Address - Phone:678-622-8530
Mailing Address - Fax:
Practice Address - Street 1:3033 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5678
Practice Address - Country:US
Practice Address - Phone:770-518-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist