Individual
DYNISHA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
1061 HARMON AVENUE, FORT STEWART, GA 31314-5674
(912) 435-6965
Mailing address
1061 HARMON AVENUE, FORT STEWART, GA 31314-5674
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS49963
FL
183500000X
Pharmacist
RPH027409
GA
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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