Provider Demographics
NPI:1619453248
Name:DEKA, RAHIMA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:RAHIMA
Middle Name:
Last Name:DEKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7699
Practice Address - Country:US
Practice Address - Phone:770-339-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-06-26
Deactivation Date:2021-04-12
Deactivation Code:
Reactivation Date:2024-02-15
Provider Licenses
StateLicense IDTaxonomies
GARPH030686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist