Individual
EBONY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 HILLCREST PKWY, DUBLIN, GA 31021-4366
(478) 277-3085
Mailing address
456 BRIDGEMILL DR, EAST DUBLIN, GA 31027-8313
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH024954
GA
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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